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BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

The effect of out-of-pocket costs and financial rewards in a discrete choice experiment: an application to lifestyle programs

Authors: Johanna O P Wanders, Jorien Veldwijk, G Ardine de Wit, Huberta E Hart, Paul F van Gils, Mattijs S Lambooij

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

Both out-of-pocket costs and financial rewards can be used to influence health related behavior. However, it is unclear which of these two has a larger effect on health related behavior. The aim of this study was to explore the possible difference in effect size between out-of-pocket costs and financial rewards on the willingness of diabetes mellitus type 2 (DM2) patients to participate in a lifestyle program.

Methods

A discrete choice experiment (DCE) questionnaire was sent to 767 DM2 patients in a geographically defined area (De Leidsche Rijn, Utrecht) in The Netherlands and completed by 206 of them. The questionnaire comprised of 18 choice tasks of which 9 contained a financial reward for lifestyle program completion, while the other 9 included out-of-pocket costs for program participation. In a second version of the questionnaire, the order of out-of-pocket cost and financial reward choice tasks was counterbalanced to reduce bias with respect to the position (first or second) of the two types of choice tasks. Panel-mixed-multinomial-logit models were used for data analysis.

Results

Increasing out-of-pocket costs were associated with a decreasing willingness to participate in a lifestyle program and, contrary to our expectations, increasing financial rewards were also associated with a decreasing willingness to participate in a lifestyle program. In addition, this willingness to participate changed to the same extent for both increasing out-of-pocket costs and increasing financial rewards.

Conclusions

As expected, increasing out-of-pocket costs may prevent people from deciding to participate in a lifestyle program. However, offering a financial reward to persuade people to participate in a lifestyle program, may result in decreasing willingness to participate in a lifestyle program as well.
Appendix
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Literature
1.
2.
Chaloupka FJ, Yurekli A, Fong GT: Tobacco taxes as a tobacco control strategy. Tob Control. 2012, 21 (2): 172-180.CrossRefPubMed
3.
Wilson NA, Thomson GW: Tobacco tax as a health protecting policy: a brief review of the New Zealand evidence. N Z Med J. 2005, 118 (1213): No 1213-
4.
Spence J, Holt N, Dutove J, Carson V: Uptake and effectiveness of the Children’s Fitness Tax Credit in Canada: the rich get richer. BMC Public Health. 2010, 10: 356-CrossRefPubMedPubMedCentral
5.
Schmidt H: Bonuses as incentives and rewards for health responsibility: a good thing?. J Med Philos. 2008, 33 (3): 198-220.CrossRefPubMed
6.
Volpp KG, Troxel AB, Pauly MV, Glick HA, Puig A, Asch DA, Galvin R, Zhu J, Wan F, DeGuzman J, Corbett E, Weiner J, Audrain-McGovern J: A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 2009, 360 (7): 699-709.CrossRefPubMed
7.
8.
Kahneman D, Tversky A: Prospect theory: an analysis of decision under risk. Econometrica. 1979, 47 (2): 263-292.CrossRef
9.
Tversky A, Kahneman D: Loss aversion in riskless choice: a reference dependent model. Q J Econ. 1991, 106 (4): 1039-1061.CrossRef
10.
Sutherland K, Christianson JB, Leatherman S: Impact of targeted financial incentives on personal health behavior: a review of the literature. Med Care Res Rev. 2008, 65 (6 Suppl): 36S-78S.CrossRefPubMed
11.
Kane RL, Johnson PE, Town RJ, Butler M: A structured review of the effect of economic incentives on consumers’ preventive behavior. Am J Prev Med. 2004, 27 (4): 327-352.CrossRefPubMed
12.
Sutherland K, Leatherman S, Christianson J: Paying the patient: does it work? a review of patient-targeted incentives. 2008, ISBN: 987-1-906461-04-1
13.
14.
Lussier JP, Heil SH, Mongeon JA, Badger GJ, Higgins ST: A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction. 2006, 101 (2): 192-203.CrossRefPubMed
15.
Lancsar E, Louviere J: Conducting discrete choice experiments to inform healthcare decision making: a user’s guide. Pharmacoeconomics. 2008, 26 (8): 661-677.CrossRefPubMed
16.
Ryan M, Gerard K, Amaya-Amaya M: Using Discrete Choice Experiments to Value Health and Health Care. 2008, Dordrecht: SpringerCrossRef
17.
Dube MC, Valois P, Prud’homme D, Weisnagel SJ, Lavoie C: Physical activity barriers in diabetes: development and validation of a new scale. Diabetes Res Clin Pract. 2006, 72 (1): 20-27.CrossRefPubMed
18.
Forbes CC, Plotnikoff RC, Courneya KS, Boule NG: Physical activity preferences and type 2 diabetes: exploring demographic, cognitive, and behavioral differences. Diabetes Educ. 2010, 36 (5): 801-815.CrossRefPubMed
19.
Lakerveld J, Ijzelenberg W, van Tulder MW, Hellemans IM, Rauwerda JA, van Rossum AC, Seidell JC: Motives for (not) participating in a lifestyle intervention trial. BMC Med Res Methodol. 2008, 8: 17-CrossRefPubMedPubMedCentral
20.
Nagelkerk J, Reick K, Meengs L: Perceived barriers and effective strategies to diabetes self-management. J Adv Nurs. 2006, 54 (2): 151-158.CrossRefPubMed
21.
Owen K, Pettman T, Haas M, Viney R, Misan G: Individual preferences for diet and exercise programmes: changes over a lifestyle intervention and their link with outcomes. Public Health Nutr. 2010, 13 (2): 245-252.CrossRefPubMed
22.
Roux L, Ubach C, Donaldson C, Ryan M: Valuing the benefits of weight loss programs: an application of the discrete choice experiment. Obes Res. 2004, 12 (8): 1342-1351.CrossRefPubMed
23.
Thomas DE, Elliott EJ, Naughton GA: Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006, 3: CD002968-PubMed
24.
25.
van Gils PF, Lambooij MS, Flanderijn MH, van den Berg M, de Wit GA, Schuit AJ, Struijs JN: Willingness to participate in a lifestyle intervention program of patients with type 2 diabetes mellitus: a conjoint analysis. Patient Prefer Adherence. 2011, 5: 537-546.CrossRefPubMedPubMedCentral
26.
Vijan S, Stuart NS, Fitzgerald JT, Ronis DL, Hayward RA, Slater S, Hofer TP: Barriers to following dietary recommendations in Type 2 diabetes. Diabet Med. 2005, 22 (1): 32-38.CrossRefPubMed
27.
Wood FG: Ethnic differences in exercise among adults with diabetes. West J Nurs Res. 2002, 24 (5): 502-515.CrossRefPubMed
28.
Krueger RA, Casey MA: Focus Groups: A practical guide for applied research. 2000, Thousand Oaks: Sage Publications, Inc.CrossRef
29.
Veldwijk J, Lambooij MS, van Gils PF, Struijs JN, Smit HA, de Wit GA: Type 2 diabetes patients’ preferences and willingness to pay for lifestyle programs: a discrete choice experiment. BMC Public Health. 2013, 13: 1099-CrossRefPubMedPubMedCentral
30.
Huber J, Zwerina K: The importance of utility balance in efficient choice designs. J Market Res. 1996, 33 (3): 307-317.CrossRef
31.
Bliemer MCJ, Rose JM: Efficiency and sample size requirments for stated choice experiments. 2009, Washington DC: Transportation Research Board Annual Meeting
32.
Bech M, Gyrd-Hansen D: Effects coding in discrete choice experiments. Health Econ. 2005, 14 (10): 1079-1083.CrossRefPubMed
33.
Marsh LC, Cormier DR: Spline Regression Models. 2002, Thousand Oaks, CA: Sage Publications, IncCrossRef
34.
Guimaraes C, Marra CA, Colley L, Gill S, Simpson S, Meneilly G, Queiroz RH, Lynd LD: Socioeconomic differences in preferences and willingness-to-pay for insulin delivery systems in type 1 and type 2 diabetes. Diabetes Technol Ther. 2009, 11 (9): 567-573.CrossRefPubMed
35.
Blau PM: Exchange and power in social life. 1964, New York: John Wiley & sons
36.
Allan C, Radley A, Williams B: Paying the price for an incentive: an exploratory study of smokers’ reasons for failing to complete an incentive based smoking cessation scheme. J Health Serv Res Policy. 2012, 17 (4): 212-218.CrossRefPubMed
37.
Kohn A: Why incentive plans cannot work. Harv Bus Rev. 1993, 71 (5): 54-60.
38.
Gneezy U, Meier S, Rey-Biel P: When and why incentives (don’t) work to modify behavior. J Econ Perspect. 2011, 25 (4): 191-210.CrossRef
39.
Bogelund M, Vilsboll T, Faber J, Henriksen JE, Gjesing RP, Lammert M: Patient preferences for diabetes management among people with type 2 diabetes in Denmark - a discrete choice experiment. Curr Med Res Opin. 2011, 27 (11): 2175-2183.CrossRefPubMed
40.
Hauber AB, Mohamed AF, Johnson FR, Falvey H: Treatment preferences and medication adherence of people with Type 2 diabetes using oral glucose-lowering agents. Diabet Med. 2009, 26 (4): 416-424.CrossRefPubMed
41.
Marshall D, Bridges JF, Hauber B, Cameron R, Donnalley L, Fyie K, Johnson FR: Conjoint analysis applications in health - how are studies being designed and reported?: an update on current practice in the published literature between 2005 and 2008. Patient. 2010, 3 (4): 249-256.CrossRefPubMed
42.
Lynagh MC, Sanson-Fisher RW, Bonevski B: What’s good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change. Int J Behav Med. 2013, 20 (1): 114-120.CrossRefPubMed
43.
O’Donoghue T, Rabin M: Doing It Now or Later. Am Econ Rev. 1999, 89 (1): 103-124.CrossRef
44.
de Bekker-Grob EW, Ryan M, Gerard K: Discrete choice experiments in health economics: a review of the literature. Health Econ. 2012, 21 (2): 145-172.CrossRefPubMed
Metadata
Title
The effect of out-of-pocket costs and financial rewards in a discrete choice experiment: an application to lifestyle programs
Authors
Johanna O P Wanders
Jorien Veldwijk
G Ardine de Wit
Huberta E Hart
Paul F van Gils
Mattijs S Lambooij
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-870

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