Incentives and interventions
George Anesi
Issue date: 12/5/08 Section: Opinion
"Incentives," which I have mentioned frequently in this column over the past two years, are an economic principle based on the assumption that rational actors will make decisions in predictable ways based on the visible set of rewards and costs laid out before them.
I mention incentives frequently because they are profoundly powerful forces that can alter decision-making and should therefore be considered whenever policy or practice guidelines are being discussed that seek to achieve a certain desired outcome. In other words, when we want people to act in a certain way (i.e. to live healthier lives), it is imperative that we look at the incentive driving the decisions that will get them there or prevent them from doing so.
An area in medicine where incentives take on a significant ethical flavor is that of the treatment of, or intervention in, activities that are both harmful and avoidable. Some of the more obvious examples include needle exchanges for intravenous drug users, bariatric surgery and other surgical treatments for obesity, and the exquisitely sensitive examples involving sex such as condom distribution, comprehensive sexual education, and vaccination for the human papillomavirus (HPV) for teenagers.
The common paradigm here is that a treatment or intervention is offered to improve the outcome of a potentially harmful activity for which the very harm we are afraid of could be prevented by abstaining. Critics of these types of interventions (and there is by no means a single group of critics that objects to all of these different interventions) often cite incentives in their argument: when an intravenous drug user is offered free clean needles, a strong disincentive to using such drugs (infection with HIV, hepatitis, etc.) is removed; equivalently, there has been a net gain in incentives to use such drugs.
Likewise, individuals may be less inclined to watch their weight or combat existing obesity with lifestyle modification if the option of surgery is available down the road, and teenagers may believe sex is safer (of course, a true statement) and have more sex (a complex issue, and more on this in a minute) when they have been vaccinated for HPV, and have access to condoms and know how and why to use them.
I mention incentives frequently because they are profoundly powerful forces that can alter decision-making and should therefore be considered whenever policy or practice guidelines are being discussed that seek to achieve a certain desired outcome. In other words, when we want people to act in a certain way (i.e. to live healthier lives), it is imperative that we look at the incentive driving the decisions that will get them there or prevent them from doing so.
An area in medicine where incentives take on a significant ethical flavor is that of the treatment of, or intervention in, activities that are both harmful and avoidable. Some of the more obvious examples include needle exchanges for intravenous drug users, bariatric surgery and other surgical treatments for obesity, and the exquisitely sensitive examples involving sex such as condom distribution, comprehensive sexual education, and vaccination for the human papillomavirus (HPV) for teenagers.
The common paradigm here is that a treatment or intervention is offered to improve the outcome of a potentially harmful activity for which the very harm we are afraid of could be prevented by abstaining. Critics of these types of interventions (and there is by no means a single group of critics that objects to all of these different interventions) often cite incentives in their argument: when an intravenous drug user is offered free clean needles, a strong disincentive to using such drugs (infection with HIV, hepatitis, etc.) is removed; equivalently, there has been a net gain in incentives to use such drugs.
Likewise, individuals may be less inclined to watch their weight or combat existing obesity with lifestyle modification if the option of surgery is available down the road, and teenagers may believe sex is safer (of course, a true statement) and have more sex (a complex issue, and more on this in a minute) when they have been vaccinated for HPV, and have access to condoms and know how and why to use them.
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Jennyroddick
Jennyroddick
posted 3/19/09 @ 1:07 AM EST
This is a very excellent article about incentives and interventions.In the medicine area incentives take on a significant ethical flavor is that of the treatment of, or intervention in, activities that are both harmful and avoidable. (Continued…)
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