Opposing points of view were published yesterday on BMJ.com regarding the significance of paying cash incentives to poor people with the expectation that they will make lifestyle changes and monitor their health more effectively when they know they will get paid to do so.

Richard Cookson, of the University of York, says incentives will save taxpayer dollars, equalize health care between social classes, and improve overall health of a population.

Jennie Popay, of Lancaster University, says these policies are proposed by people who have “little understanding of how to survive poverty.”

Citing examples of pay incentives already in existence, Cookson says the example is working in the US medical system where Medicaid emphasizes screening and treatment of chronic disease and in Chile where a program called Solidario targets healthcare for children and their mothers.

Cookson says the unhealthy behaviors of impoverished people places a huge burden of cost on society in general but making preventive health measures more attractive by paying cash is proving to be an effective means of getting more people to take advantage of preventive services.  He further states that a nation’s public benefits system makes these particular individuals easy to identify but does acknowledge that there is not enough data available at this time to determine if these measures are cost effective or not.

Popay, however, describes the process of identifying and labeling the people expected to take advantage of these services as merely adding to the “multiple humiliations” with which impoverished people live.

Popay says cash incentives are costly and stigmatizing, with no track record of lasting impact on either society in general or in the personal lives of the individuals receiving the cash incentives.  She further states that the behaviors deemed unhealthy by government and medical standards are often actually coping mechanisms that make life in unrelenting poverty a bit less miserable.  Popay feels any immediate benefits derived from the cash incentives is not lasting, that people will lapse back into unhealthy behaviors when it is discovered how little they affect an impoverished life in general, and that other unhealthy behaviors are likely to be adopted once it becomes obvious the cash incentives do not break the cycle of poverty in an individual’s life.

Source: British Medical Journal