Will Your Dentist Fine You For Not Flossing?

We don’t always pay attention to dentists or other medical professionals. They tell us to stop smoking, eat healthier, exercise more, floss regularly, quit swilling sugary drinks … and we smile, say yes, go home and contemplate the utter blank horror of life without our favorite bad habit.

The more dedicated among us – or those who have gotten a really dire warning from their healthcare provider – may actually make long term change, of course, but it’s still really hard to permanently shed those bad habits after the initial jolt of terror/enthusiasm has faded.

Even cold, hard cash can’t consistently motivate people to make positive changes, though it certainly seems to help. Medical researchers, health-care providers and insurers have been experimenting with offering financial rewards to those who follow medical advice. Unfortunately, results have been mixed.

The most recent study, published in the New England Journal of Medicine, involved 2,538 participants (all employees of CVS) who smoked tobacco. All of those who accepted the challenge to quit the habit were divided into a penalty group and a reward group. Each person in the penalty group forfeited $150; six months later, if they had stopped smoking for the duration, they would get the deposit back along with a $650 bonus. In the reward-group participants were simply paid $800 if they managed to quit smoking for six months.

The results: only 9.4 percent of those in the reward group succeeded in quitting smoking. The group with the most to lose were the big winners – over 16% of them managed to stay away from cigarettes for six months.

It’s quite possible that those who are motivated and confident enough to consider paying a deposit that they may forfeit may be more likely to meet their goal. But many studies have indicated that losing money is more motivating than earning a cash reward.  Humans are loss averse – we’re much more concerned about losing what we already possess than we are about gaining something new.

Two other studies, reported last winter, indicated that small amounts of money had no effect on people’s behavior. One offered HIV patients up to $280 a year to take their pills daily; the other offered people $25 to take an HIV test and $100 to come back to get the results. Getting the test and then showing up to receive the results would seem to be a no brainer, especially with the added $125 bonus, but there was virtually no change in compliance, researchers said.

Research models do predict that $5,000 a year is the magic number – and it’s not hard to foresee that pretty much anyone can change any bad health habit when that sum is up for grabs. But the studies also indicate that the proverbial stick and carrot both need to be deployed to make a measurable difference. Just awarding you $5000 isn’t a sure-fire way of ensuring that you break a bad habit, or establish a positive one.

It’s unlikely that anyone is going to offer you a few grand as a reward for consistent teeth flossing or doing whatever it is that medical professionals want you to do. That is, unless you are a much-valued CEO of a global corporation. It is, however, possible that large companies and insurers may begin to experiment with smaller  financial incentives for employee wellness programs.

The study of financial rewards and losses is called behavioral economics, and has spawned websites such as dietbet.com, where people pay to play and then split the proceeds if they meet their weight loss goal. There’s also StickK.com where people can select a goal, as well as determine how much to forfeit if they don’t meet that goal, and choose a “referee” to monitor the process. If they lose, the money is donated to a charity they chose – and some suggest picking a charity whose cause you do not support is the best motivation of all.

No everyone chooses to take on the challenge of the forfeit, but those who do are far more likely to achieve their goal. StickK claims that those who simply select a objective and sign a contract, 29 percent achieve their goal. When they also agree to a financial forfeit and have a referee to enforce that agreement – nearly 80 percent meet their goal.

So, while your dentist may not fine you every time you miss a checkup, it’s quite possible that money-based incentives may play a role in your healthier lifestyle soon.


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