Patient health incentives: ethical challenges and frameworks

Patient incentives for encouraging healthy behavior raise a number of ethical concerns: Do they target the vulnerable? Do they involve psychological manipulation? Do they undermine intrinsic motivation?

To the purpose of this paper is to provide an overview of ethical challenges raised by patient incentives and incentive programs and develop a systematic approach to understanding and analyzing these ethical challenges.

Ethical considerations raised by patient incentives can be broadly grouped into two kinds: medical ("patient-oriented") and public health ("constituent-oriented") concerns. Ethical frameworks suitable to these kinds of concerns are explored.

Two ethical frameworks are applied to the challenges raised by patient incentives: (1) Incentives are assessed in terms of personal and social responsibility for health; and (2) incentives are assessed as elements of normatively structured clinical relationships (e.g., the traditional patient-clinician relationship).

A better understanding of ethical concerns and the resources available within the personal responsibility and clinical encounter frameworks suggest complementary guidance may be available for approaching many of the ethical issues raised by patient incentives.