Study: Health incentives can backfire if they penalize the overweight

Like other employers across the nation, hospitals try to keep insurance premium costs low by offering incentives to staff to lead healthy lifestyles. But new research suggests that these incentives could backfire if they appear to penalize staff for being overweight. 

The research, published in Psychological Science, a journal of the Association for Psychological Science, shows policies that carry higher premiums for overweight individuals are perceived as punishing and stigmatizing, according to an announcement.

In one study, 126 participants were told that due to rising healthcare costs, which they blamed in part to overweight employees, forced the company to change is policies. Participants were shown one of four final policy decisions: a "carrot" plan that offered a $500 premium reduction to "healthy-weight people"; a "stick" plan that increased premiums of overweight people by $500; and two other stick plans that resulted in a $2,400 insurance premium for overweight employees.

Participants viewed the stick plans as punishment for being overweight and were less likely to endorse them. Lead researcher David Tannenbaum of the Anderson School of Management at the University of California, Los Angeles, said participants appeared to evaluate the plan options on moral grounds, deciding that punishing someone for being overweight was wrong regardless of the potential savings.

A second study was designed to see if the "stick" and "carrot" plans actually reflected different underlying attitudes. Researchers found participants who showed high levels of bias against overweight people were more likely to choose the "stick" plan, but provided different justification depending on whether their bias was explicit or implicit.

"Participants who explicitly disliked overweight people were forthcoming about their decision, admitting that they chose a 'stick' policy on the basis of personal attitudes," Tannenbaum said in the announcement. "Participants who implicitly disliked overweight people, in contrast, justified their decisions based on the most economical course of action."

But Tannenbaum said if the participants who implicitly disliked overweight people were truly focused on economic concern, they would have opted for the "carrot" plan, since it would save the company $100 per employee. Instead, these participants tended to choose the strategy that effectively punished overweight people, even in instances when the "stick" policy implied a financial cost to the company.

The research suggests organizations should consider the nature of their messages when rolling out policies, Tannenbaum said. Policymakers should realize that the framing of incentive programs can convey tacit, and sometimes stigmatizing, messages.

To learn more:
- here's the research abstract and study (subscription required)
- read the announcement

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