Whiskey

Should the NHS pay me to stop drinking?

By: Ben Gowland CEO NHS Nene Clinical Commissioning Group @ccginsider
Published: Friday, January 9, 2015 - 09:14 GMT Jump to Comments

Ben Gowland asks "Should the NHS take a more active approach and provide real financial incentives to help us keep our New Year resolutions to stop drinking and smoking?"

With the incoming of the New Year, many of us will have made a list of the things that we are going to stop doing. For my New Year’s resolution this year I am going to stop drinking in January! But given that the NHS will win most of the financial benefit of my decision, should the NHS be paying me to stop?

This might sound ridiculous, and it is type of suggestion that makes many bristle. But if it is cheaper for the NHS to stop me drinking than to treat me for liver disease or other alcohol related diseases, surely it makes sense for the NHS to provide me with a financial incentive to stop drinking?

Incentives can make a difference. Halle Tecco from Rock Health tells the story of how, in the 1800’s, the British colonies were sending their prisoners to Australia, and the ship's captains were being paid for each prisoner they transported. Because the captains were incentivised to take as many prisoners as possible, the ships were hugely overcrowded and only about half of the passengers would survive the trip. 

Economist Edwin Chadwick suggested a change in the incentive structure for the ships’ captains. Instead of paying them for every passenger that boarded the ship in the UK, they would pay them for every passenger that stepped off the ship alive in Australia. They did this, and the survival rates increased from 50% to 98%.

Incentive schemes have been tried in health, with similar success. Research undertaken at Newcastle University found that smokers taking part in schemes where they received a financial reward to stop smoking (they exist) were more than twice as likely to give up for six months than those simply given advice to stop. In fact, across all preventive activities the research showed that incentives increased the odds of behaviour being changed by 62%.

But we can’t help but react to the suggestion of anyone being paid not to do something that they potentially should not have been doing in the first place. Surely the financial incentive for smokers or drinkers comes from the money they save in not purchasing cigarettes or alcohol? Surely we should not be paying them an incentive payment to quit as well? 

We struggle because it feels like, through the act of providing incentives, we are rewarding the ‘bad’ behaviour of those who smoke or drink, and implicitly punishing the ‘good’ behaviour of those who don’t smoke or drink because they are not eligible for the incentive. So, even though the financial case for providing incentives is sound (it is far cheaper to pay the incentive money than the healthcare costs of those who continue to smoke or drink), we get lost in these debates and as a result many areas do not offer this type of scheme.

While the financial responsibility for my health sits with the NHS, ultimately I am the one that has to live with the health consequences. The NHS can’t take responsibility for me, and the risk with providing incentives is that despite the short term gain, what it does is reinforce the notion that my health is not my responsibility. We don’t want to end up with a situation whereby I decide whether or not to stop drinking depending on the size of the financial incentive that the NHS is prepared to pay me.

But, despite what the Katie Hopkins of this world may think, some of us need help when we have made a decision to change our behaviour in making that change happen. This is where I think the NHS has a real role in partnering with individuals who want to improve their health outcomes by giving them whatever support they need to achieve their goals.

For the NHS the time has come, according to new guidance for next year, to help all of us ‘get serious about prevention’. For me, the time has come to stop drinking alcohol (well, for January at least!). We have to take ownership of our health, we have to be serious about prevention as individuals, and the NHS has to support us where it can, but never take ultimate responsibility away from us. My health is my responsibility, and that is the reason why I won’t be drinking this January.

The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Information Daily, its parent company or any associated businesses.

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