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An Economic Framework for User Financial Incentives for Health Behaviour Change

Meads, David Michael (2016) An Economic Framework for User Financial Incentives for Health Behaviour Change. PhD thesis, University of Leeds.

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Background: Diseases such as stroke and heart disease are chiefly caused by unhealthy behaviours and are a major societal burden. User financial incentives are being explored as a way to encourage healthier lifestyles. This research developed a framework to provide information on pricing and cost-effectiveness of incentives and guide design of future incentive schemes. Methods: The workstreams were: a) structured, configurative literature review to identify neo-classical/behavioural economic explanations for behaviour change and incentives; b) contingent valuation survey to identify willingness to accept (WTA) and incentive pricing; c) systematic review and meta-analysis of incentives for weight loss; d) development of decision-analytic model to estimate cost-effectiveness of incentives for weight loss. Results: The reviews identified a number of factors important for understanding the effect of incentives including internal motivation, self-control and time preference. A theoretical framework of incentive impact was developed to facilitate WTA survey design. The WTA survey was completed by 112 people (n=56 at 3 months). 57% strongly disagreed with incentive use. The mean incentive required per month depended on behaviour, ranging £103.69 for smoking cessation to £45.43 for reducing alcohol intake. The most important predictors of WTA were self-control, perceived difficulty of change and attitudes to incentives. There was some evidence that WTA incentives increased over time. Review and meta-regression provided efficacy parameters for the decision-analytic model which comprised the following health states: healthy, type II diabetes, stroke, myocardial infarction and dead. Analyses from NHS and employer perspectives indicated incentives for weight loss are cost-effective over a lifetime as they dominated usual care. Discussion: Incentives may be most powerful if they are personalised to account for individual factors and attitudes and are dynamic in response to these. Incentives may be cost-effective in a number of scenarios. Further research is required on the long term outcomes of incentives and financing models.

Item Type: Thesis (PhD)
Keywords: Health economics, Financial incentives, behaviour change
Academic Units: The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Health Sciences (Leeds) > Academic Unit of Health Economics (Leeds)
Identification Number/EthosID: uk.bl.ethos.689286
Depositing User: Mr David Meads
Date Deposited: 30 Jun 2016 10:53
Last Modified: 25 Jul 2018 09:52
URI: http://etheses.whiterose.ac.uk/id/eprint/13458

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