Doing 'the right thing' for one's health, be it eating well, exercising, or going for an annual HIV test or blood pressure check, is easier said than done. One way to nudge people to make these 'right' decisions is to offer rewards or incentives. Discovery Health Medical Scheme's Vitality programme is probably the best local example of such an incentive programme.
As Spotlight has recently reported, South Africa is doing relatively poorly against its diabetes and hypertension targets and substantially better against its HIV targets. Yet, we can find no evidence that the Department of Health has given serious thought to incentive programmes in these various areas.
Venter says that while hugely complex issues like controlling non-communicable diseases and obesity can't be solved with incentives, they could certainly be added to the very limited toolbox of the existing arsenal being used to prevent disease or death through early detection, testing, and screening. He says incentives"definitely should not be dismissed right off the bat when it comes to the 84% of people who rely on the public system".
According to a Discovery report, the"overall impact of Vitality on mortality rates is significant". By"making people healthier" they say they have achieved an average reduction in mortality of 13%. Late diagnosis or poor disease control has high human and economic costs in both the public sector and private. According to a 2013 study published in the Global Health Action journal, uncontrolled diabetes caused 8 000 new cases of blindness and 2 000 new amputations in South Africa in 2009 alone. More recent statistics reveal the situation is getting worse.
"It's really important to appreciate that there are so many environmental, social, [and] structural factors that make it difficult for people to quote-unquote 'do the right thing' when it comes to health-related behaviours," says Thirumurthy."For example, people are constantly subjected to advertising of unhealthy food products. Many are living in environments that make it hard to eat a healthy diet even if they wanted to.
According to Thirumurthy, incentive-based interventions represent one creative solution with the potential to help improve health outcomes and reduce the financial burden on the health system in the long term."I'm not saying incentives or rewards-based programmes are going to save the day, so to speak. However, they do represent a small but important part of an overall policy package that is necessary to address NCDs.
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