Should patients be paid to take their treatment?

Ensuring that patients adhere to their prescribed treatments is one of the most significant challenges in healthcare today. Non-adherence can lead to worsened health outcomes, increased hospitalizations, and higher healthcare costs¹. A growing body of evidence suggests that motivating patients to follow their treatments involves a complex interplay of psychological factors². Among the strategies proposed, monetary incentives—an example of extrinsic motivation—have sparked both interest and debate³. However, research suggests the need to focus more on fostering intrinsic motivation⁴. In a study involving patients undergoing antiretroviral therapy for HIV/AIDS, those with optimal adherence appeared to attribute the majority of their treatment behaviors to intrinsic motivation rather than extrinsic motivation⁵.

Understanding Motivation: Intrinsic vs. Extrinsic

Motivation can be classified into two primary types:

Extrinsic Motivation: This arises from external rewards or pressures. For example, financial incentives, discounts, or gift cards provided for taking medication or attending medical appointments^6-8.
Intrinsic Motivation: This is driven by internal factors such as personal values, a sense of accomplishment, or the desire to lead a healthier life⁹.

The Problem with Extrinsic Motivation

While extrinsic rewards may lead to immediate behavior change, their impact is often temporary. Studies have shown that once the reward is removed, adherence typically declines, sometimes to levels lower than before the intervention. This phenomenon, known as the overjustification effect, occurs when external rewards undermine intrinsic motivation by shifting focus away from internal values⁶.

Evidence Supporting the Limitations of Extrinsic Motivation

Short-Term Compliance: A study examined the impact of financial incentives on medication adherence among patients with hypertension. It found a modest improvement during the reward period, but adherence dropped once the incentives ceased⁷.
Undermining Long-Term Commitment: Research in behavioral science highlights that extrinsic rewards can create dependency, where individuals begin to associate the desired behavior (e.g., taking medication) exclusively with the reward. Once the incentive is removed, patients may no longer feel motivated to maintain the behavior^6,8.
Counterproductive Outcomes: In some cases, monetary rewards can lead to a transactional view of health. Patients might begin to question the value of behaviors that are not externally rewarded, potentially decreasing adherence in areas where incentives are absent^6,7.

The Case for Fostering Intrinsic Motivation

Building intrinsic motivation is a more sustainable and empowering approach. When patients understand the value of their treatment and feel in control of their health, they are more likely to adhere to recommendations over the long term⁹.

Strategies to Enhance Intrinsic Motivation

Education and Shared Decision-Making: When patients understand the “why” behind their treatment and are actively involved in decision-making, they are more likely to adhere to their regimen¹⁰.
Supportive Healthcare Relationships: Trust and communication between healthcare providers and patients are critical. Providers who listen, empathize, and offer encouragement can strengthen intrinsic motivation by affirming the patient’s role in their own care¹¹.
Behavioral Nudges: Simple, non-monetary nudges like reminders, positive reinforcement, or framing adherence as part of a broader goal (e.g., being healthy for loved ones) can be effective^12,13. Behavioral economics research suggests that such low-cost interventions can impact adherence without undermining intrinsic motivation¹⁴.
Creating Meaningful Goals: Helping patients connect their health behaviors to personal values—such as being able to play with their grandchildren or achieve professional aspirations—can create a powerful internal drive^15,16.

A Balanced Approach

While extrinsic motivators, such as financial incentives, may play a limited role in kickstarting behavior change for certain populations, they should never replace efforts to cultivate intrinsic motivation. A well-rounded strategy should combine:

Initial external motivators for immediate adherence, if necessary.
A robust framework to transition patients toward intrinsic motivation through education, empowerment, and ongoing support¹⁷.

Conclusion

Paying patients to take their treatment may seem like a quick fix for a complex issue, but it is not a sustainable solution. Extrinsic motivation, while useful in the short term, risks undermining the very behaviors it seeks to promote. Healthcare systems and providers should focus on fostering intrinsic motivation by empowering patients, building trust, and aligning treatments with patients’ personal values¹⁸. Such efforts not only improve adherence but also enhance the patient experience and overall health outcomes.

By reallocating resources from financial incentives to intrinsic motivation-building strategies, healthcare systems can achieve more meaningful, lasting results.

This article was written with the assistance of generative AI technology and reviewed for accuracy.