Searching For Satisfaction

When Money Is the Motivator

Posted on: June 16, 2010


On Sunday the NYTimes had an interesting article that peaked my interest.  The topic?  Paying folks to take their medication.  The article, For Forgetful, Cash Helps the Medicine Go Down, gives some compelling reasons on why paying people to take their medicine is needed.

One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker.

Now, a controversial, and seemingly counterintuitive, effort to tackle the problem is gaining ground: paying people money to take medicine or to comply with prescribed treatment. The idea, which is being embraced by doctors, pharmacy companies, insurers and researchers, is that paying modest financial incentives up front can save much larger costs of hospitalization.

“It’s better to spend money on medication adherence for patients, rather than having them boomerang in and out of the hospital,” said Valerie Fleishman, executive director of the New England Healthcare Institute, a research organization, who said that about one-tenth of hospital admissions and one-quarter of nursing home admissions result from incorrect adherence to medication. “Financial incentives are a critical piece of the solution.”

The article also highlighted people in cash-for-meds programs for their feedback.

I gotta say, when I read this article, I immediately gave the paper the O_o.  Paying people for taking their medication?  I’m so not down for that.  Why do I have to pay you for you to do something which benefits you & not me?  Shouldn’t your health & not dying be enough of a motivator to take your meds?  And if you don’t care whether you live or die, then why should I?

After pondering the article & the implications a bit, I started thinking about how we got to this point.  It seems like there are incentives for everything nowadays.  You want folks to recycle their bottles & cans, so some states (like my home state of MI) have a refundable deposit system.  You want folks to bring their own reusable bags to Whole Foods, so you give them a discount for each bag they bring.

But at what point do these incentives become dangerous and cross the line?  What immediately came to mind to me was paying kids to go to school and paying kids to get good grades.  Sure, in the short-term everyone’s happy: kids are in school, schoolwork is completed, dropout rates go down, hopefully graduation rates go up.  But what happens when the source for the payments or prizes dries up, and students are no longer rewarded for their attendance or grades?   As noted in the NPR piece,

But critics say school administrators should not be turning the schoolhouse into a workplace. Rather than motivate students, they charge, the reward programs cheapen the educational experience by using “bribes” to win temporary obedience.  Psychological studies going back as far as the early 1970s have found that rewards programs may produce less engaged students. These studies suggest that, instead of developing an intrinsic love of learning, young people are being trained to do the minimum amount needed to get the reward, and then they lose interest.

What are we teaching our kids, when we reward them with money and other prizes for doing the things they should be doing?  And what happens to the kids who were doing the right things in the first place, without the carrot of a possible tangible reward?  Does that diminish their desire to be self-motivated & do what’s best for their future, because they know others get paid but they don’t?

At some point people have to take personal responsibility for their actions.  Whether its a teenager who won’t go to class, or a person who refuses to take their high blood pressure medication, everyone needs to be held responsible for what they do or don’t do.  Don’t want to go to class?  Ok, suffer the consequences of being an uneducated person in this society with little to no employment prospects.  Don’t want to take your medication?  Ok, suffer the pain & possible death as a result of your inaction.  At some point, we have to leave people to deal with the consequences of their decisions.  We can’t save everyone.  Paying people to do things that they should have more than enough motivation to do serves to reward bad behavior & choices, as well as unmotivating those who have been making good choices without the appeal of a reward.

Am I wrong here?  Thoughts?  Are you ok with paying people to do things that they should be doing anyway?  Leave a comment.

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7 Responses to "When Money Is the Motivator"

How about, FINING them for NOT taking their meds instead of rewarding them FOR taking them?

You know I love reading your blog, and I agree with you most of the time, but I just can’t here. I fully understand the point you’re trying to make here, and while I agree with the premise of it, I think this particular issue was the wrong place to make it. Yes, you ought not have to pay people to do what they’re supposed to do, but the primary issue that can’t be ignored is the simple fact that the wealthiest nation in the world somehow can’t (and, depending on who you talk to, doesn’t WANT to) provide health care insurance for ALL of its citizens.

Medication is expensive, point blank, period. These are desperate times, and desperate times call for desperate measures, and just in case anyone has forgotten how dire things are, especially here in MI, then the story of the unemployed, uninsured woman shooting herself in the shoulder to get treatment for a previous injury should be a sufficient reminder (http://bit.ly/cLVK6n). If the greed and dishonesty of those controlling this country’s money wasn’t so rampant, we wouldn’t have situations like this.

If I sound sensitive about this, it’s because I have to live with this reality everyday. My wife, college educated, advanced degreed, and highly credentialed, has no health insurance because the kind of coverage she needs to treat her preexisting conditions is far more expensive than we can possibly afford right now. It’d be really easy if the only people struggling are people who didn’t work hard, but there’s just no explanation for the troubles of those like my wife who have worked hard all their lives, made the right decisions, and went down the correct path, only to still not be able to catch a break.

I’m sure you didn’t want to hear all of this, but again, this is sensitive to me. If we were talking just about incentives for grades, or other asinine things that cheapen the importance of achievement, then I’d be in full agreement with you, but we’re talking about health care, so I say, “by any means necessary!” When the system gets fixed, people won’t have to do crazy things like this to keep themselves and others healthy.

pastorcylar, thanks for your passionate comment.

This isn’t a debate about the cost of medication tho. These people already are getting their medication through whatever means: health insurance, Medicaid/Medicare, with their own private funds, etc. We’re talking about medication that has already been bought & paid for, but people aren’t taking it. That’s the absolute waste to me. The prescription has already been dispensed (and with many medications once its dispensed to one person, it can’t be just given to someone else) and its being wasted because the person who is supposed to take it refuses to do so…unless of course there’s the possibility that they will get paid for it.

Healthcare is a totally different debate, and I totally agree that there is no reason why the US can’t have universal healthcare for all citizens, but we won’t because of corporate greed. I’m focusing solely on the phenomenon of paying people to take medication that they have in their possession.

So I will say this… while I don’t think that you should have to pay people to do what they’re supposed to do and all that, when you brought up the consequences, that’s when I had to disagree somewhat, especially in the education regard. Yea people should have to face their consequences, the only problem is that society has to face them as a whole. If a kid doesn’t get educated and has to live with little to no employment prospects, what are they most likely to do? Whatever it is, it will often be a burden on the rest of society in some form. That lack of employment can lead to a number of things that ultimately can hurt other members of society, even if it just a financial burden to clothe, feed, incarcerate, etc.

So yea, I don’t know… and of course the educator in me feels that kids should learn for the sake of learning, but that’s not realistic. Some kids don’t have the guidance in their homes, communities, otherwise to know why education is important, so I guess you have to do whatever you have to do to get them to learn. Hopefully, once they realize the importance of it, they’ll then be able to do it for the sake of doing and do it on their own…

I like the new format by the way… much cleaner than the other blog. Well done.

But what happens if they never learn the importance of education? What if all they’ve learned is that if someone wants them to do something, they should get paid for it? I foresee a generation of folks becoming adults who refuse to do anything unless it benefits them monetarily. Next thing you know, we’ll be paying people to vote, or mow their lawns, or register their cars. There’s already a stigma against younger generations for being lazy and feeling entitled, and I think this pay for school thing may be related to why so many younger people feel like the entire world owes them something.

Okay, I see what you’re saying. When I see an unfilled prescription, I see someone without the money to fill it, not that they were negligent in getting what’s already provided for them. I guess I wasn’t able to discern the full context of your article through the excerpt you provided. Maybe I should have read the entire NYT piece first. My badd…

I am 100% with you on this. People have to take responsibility regardless of if they get paid or not. What is the reason they don’t take the meds? As a person who has gotten prescriptions and paid for them I have taken the meds as prescribed. It was not hard so I do not know what the issue is but paying them to do is so not the answer.

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