When Money Is the Motivator

On Sunday the NYTimes had an interesting article that peaked my interest.  The topic?  Paying folks to take their medication.  The article, For Forgetful, Cash Helps the Medicine Go Down, gives some compelling reasons on why paying people to take their medicine is needed.

One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker.

Now, a controversial, and seemingly counterintuitive, effort to tackle the problem is gaining ground: paying people money to take medicine or to comply with prescribed treatment. The idea, which is being embraced by doctors, pharmacy companies, insurers and researchers, is that paying modest financial incentives up front can save much larger costs of hospitalization.

“It’s better to spend money on medication adherence for patients, rather than having them boomerang in and out of the hospital,” said Valerie Fleishman, executive director of the New England Healthcare Institute, a research organization, who said that about one-tenth of hospital admissions and one-quarter of nursing home admissions result from incorrect adherence to medication. “Financial incentives are a critical piece of the solution.”

The article also highlighted people in cash-for-meds programs for their feedback.

I gotta say, when I read this article, I immediately gave the paper the O_o.  Paying people for taking their medication?  I'm so not down for that.  Why do I have to pay you for you to do something which benefits you & not me?  Shouldn't your health & not dying be enough of a motivator to take your meds?  And if you don't care whether you live or die, then why should I?

After pondering the article & the implications a bit, I started thinking about how we got to this point.  It seems like there are incentives for everything nowadays.  You want folks to recycle their bottles & cans, so some states (like my home state of MI) have a refundable deposit system.  You want folks to bring their own reusable bags to Whole Foods, so you give them a discount for each bag they bring.

But at what point do these incentives become dangerous and cross the line?  What immediately came to mind to me was paying kids to go to school and paying kids to get good grades.  Sure, in the short-term everyone's happy: kids are in school, schoolwork is completed, dropout rates go down, hopefully graduation rates go up.  But what happens when the source for the payments or prizes dries up, and students are no longer rewarded for their attendance or grades?   As noted in the NPR piece,

But critics say school administrators should not be turning the schoolhouse into a workplace. Rather than motivate students, they charge, the reward programs cheapen the educational experience by using "bribes" to win temporary obedience.  Psychological studies going back as far as the early 1970s have found that rewards programs may produce less engaged students. These studies suggest that, instead of developing an intrinsic love of learning, young people are being trained to do the minimum amount needed to get the reward, and then they lose interest.

What are we teaching our kids, when we reward them with money and other prizes for doing the things they should be doing?  And what happens to the kids who were doing the right things in the first place, without the carrot of a possible tangible reward?  Does that diminish their desire to be self-motivated & do what's best for their future, because they know others get paid but they don't?

At some point people have to take personal responsibility for their actions.  Whether its a teenager who won't go to class, or a person who refuses to take their high blood pressure medication, everyone needs to be held responsible for what they do or don't do.  Don't want to go to class?  Ok, suffer the consequences of being an uneducated person in this society with little to no employment prospects.  Don't want to take your medication?  Ok, suffer the pain & possible death as a result of your inaction.  At some point, we have to leave people to deal with the consequences of their decisions.  We can't save everyone.  Paying people to do things that they should have more than enough motivation to do serves to reward bad behavior & choices, as well as unmotivating those who have been making good choices without the appeal of a reward.

Am I wrong here?  Thoughts?  Are you ok with paying people to do things that they should be doing anyway?  Leave a comment.