The increasing rates of overweight and obesity are of concern to governments and private health insurers who bear the associated health care cost. This has prompted health insurers to seek alternative strategies with a focus on prevention. This research aimed to determine the effectiveness of personal incentive programs related to obesity prevention offered by health insurers.
A systematic review was conducted to identify evidence of the effectiveness of financial incentives provided by health insurers to promote changes in diet, physical activity and weight. Searches were carried out in PubMed and Ebscohost and supplemented by a grey literature search.
Seventeen studies were included in the review. Three studies evaluated programs incentivising diet-related behaviours, four incentivising physical activity and ten incentivising weight loss. Study design, samples size, setting and study quality varied considerably.
Effectiveness of financial incentives to achieve weight loss were mixed. The strongest evidence indicated that programs that incentivise weight loss as compared to physical activity or dietary behaviours were more effective in inducing weight loss. Programs that incentivised weight loss resulted in increased weight loss compared to non-incentivised weight loss programs (1.2kg -6.35kg over 3-13 months); however weight loss was not maintained after incentives ceased.
Incentive design also varied across studies. Studies that used only negative incentives were not as effective as those that used positive incentives. The findings suggest that the size of the incentive has a positive impact on effectiveness. However, the relationship is not always linear and is affected by other factors, such as incentive design and other behaviour change strategies implemented alongside the incentive.
This review found that incentive programs have the potential to be effective. The results will inform the modelling of the cost-effectiveness of incentives provided by private health insurers in the Australian setting.