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Hoskins K, Schmidt H. Breastfeeding, Personal Responsibility and Financial Incentives. Public Health Ethics 2021. [DOI: 10.1093/phe/phab020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Should financial incentives be offered to mothers for breastfeeding? Given the significant socioeconomic and sociodemographic differences in breastfeeding in the USA, researchers and policymakers are exploring the role of financial incentives for breastfeeding promotion with the objective of increasing uptake and reducing disparities. Despite positive outcomes in other health domains, the acceptability of financial incentives is mixed. Financial incentives in the context of infant feeding are particularly controversial given the complex obligations that characterize decisions to breastfeed. After situating the specific ethical tensions related to personal responsibility, fairness, and intrusiveness, we argue that exploring carefully designed financial incentives can be ethically justified to support breastfeeding uptake particularly given (i) established medical guidelines that support breastfeeding benefits, (ii) wide socioeconomic and racial/ethnic disparities and (iii) notable influences in the broader choice architecture of infant feeding in the USA. Additional empirical research is warranted to better understand effectiveness, cost and specific ethical concerns related to free and informed choice.
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Affiliation(s)
- Katelin Hoskins
- Perelman School of Medicine, Leonard Davis Institute of Health Economics and Center for Health Incentives & Behavioral Economics, University of Pennsylvania, USA
| | - Harald Schmidt
- Perelman School of Medicine, Leonard Davis Institute of Health Economics and Center for Health Incentives & Behavioral Economics, University of Pennsylvania, USA
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Abstract
Family planning programmes in India have historically been target-driven and incentive-based with sterilisation seen as a key component of controlling population growth. This opinion paper uses India as the backcloth to examine the ethics of using incentive policy measures to promote and secure sterilisations within communities. Whilst we acknowledge that these measures have some value in reproductive health care, their use raises specific issues and wider concerns where the outcome is likely to be permanent and life changing for the acceptor.
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Affiliation(s)
- Jeffrey Wale
- Department of Humanities & Law, Faculty of Media and Communication, Weymouth House, Bournemouth University, Poole, UK
| | - Sam Rowlands
- Department of Medical Sciences & Public Health, Faculty of Health & Social Sciences, Royal London House, Bournemouth University, Bournemouth, UK
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Hoskins K, Ulrich CM, Shinnick J, Buttenheim AM. Acceptability of financial incentives for health-related behavior change: An updated systematic review. Prev Med 2019; 126:105762. [PMID: 31271816 DOI: 10.1016/j.ypmed.2019.105762] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/03/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
Despite the successes of financial incentives in increasing uptake of evidence-based interventions, acceptability is polarized. Given widespread interest in the use of financial incentives, we update findings from Giles and colleagues' 2015 systematic review (n = 81). The objectives of this systematic review are to identify what is known about financial incentives directed to patients for health-related behavior change, assess how acceptability varies, and address which aspects and features of financial incentives are potentially acceptable and not acceptable, and why. PRISMA guidelines were used for searching peer-reviewed journals across 10 electronic databases. We included empirical and non-empirical papers published between 1/1/14 and 6/1/18. After removal of duplicates, abstract screening, and full-text reviews, 47 papers (n = 31 empirical, n = 16 scholarly) met inclusion criteria. We assessed empirical papers for risk of bias and conducted a content analysis of extracted data to synthesize key findings. Five themes related to acceptability emerged from the data: fairness, messaging, character, liberty, and tradeoffs. The wide range of stakeholders generally preferred rewards over penalties, vouchers over cash, smaller values over large, and certain rewards over lotteries. Deposits were viewed unfavorably. Findings were mixed on acceptability of targeting specific populations. Breastfeeding, medication adherence, smoking cessation, and vaccination presented as more complicated incentive targets than physical activity, weight loss, and self-management. As researchers, clinicians, and policymakers explore the use of financial incentives for challenging health behaviors, additional research is needed to understand how acceptability influences uptake and ultimately health outcomes.
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Affiliation(s)
- Katelin Hoskins
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, United States of America.
| | - Connie M Ulrich
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, United States of America; University of Pennsylvania, School of Nursing, Department of Biobehavioral Health Sciences, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States of America
| | - Julianna Shinnick
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America
| | - Alison M Buttenheim
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, United States of America; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States of America; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States of America
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