Reexamining the Ethics of Personal Responsibility

Janice Simmons, for HealthLeaders Media , September 9, 2010

Sounds great—initially. But as it turns out, the program's goals fell short. A preliminary evaluation revealed that two years after implementation, only 10% of eligible adults and 13% of eligible children even were enrolled in the enhanced benefits plan. Other patients reported limited knowledge of the program—before and after enrolling—while clinicians reportedly felt confused about the paperwork and benefit structure.

"Incentive programs should not discriminate against a class or category of people," says Virginia Hood, MBBS, a co-author of the paper. "Age, gender, race, ethnicity, and socioeconomic status should be carefully considered in designing, implementing, and interpreting results of social and behavioral interventions."

To encourage a dialogue, ACP has compiled a list of recommendations on what should be considered when implementing incentive plans, including:

  • Incentives to encourage healthy behaviors should be appropriate for the target population. Specifically, the incentive structure must not penalize individuals by withholding benefits for behaviors or actions that may be beyond their control.
  • Incentives to promote behavior change should be consistent with the elements of patient-centered care. This means the incentive structure should support appropriate patient autonomy and participation in decision making—including the right to refuse treatment—without fear of punishment.
  • Incentives should support "honest, open and fair interactions" among patients, healthcare professionals, healthcare entities and payers. In particular, health plans should not interfere with "the ability of patients to communicate freely with physicians and other health care clinicians," the paper states.
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