Points-Based Health Incentive Program and Subsequent Health and Well-Being in Japan: An Outcome-Wide Approach

Evidence remains inadequate regarding the benefits of incentive programs promoting healthy activities, particularly among older adults. This longitudinal study examined the associations of participation in the points-based health incentive program with an array of subsequent health and well-being outcomes, including ones the program did not explicitly incentivize, among older adults in Japan.

We used three-wave data (2020, 2021, and 2022) from Japan Gerontological Evaluation Study (n = 2504), a cohort study of functionally independent individuals aged ≥ 65 years. We randomly sampled individuals living in Matsudo City and collected data via self-administered mail surveys.

Our exposure was participation in the points-based health incentive program (points-program) assessed at the 2021 wave. The program awards points for health checkups, community participation, and achieving personal health goals, which can be exchanged for entry into a prize lottery. We assessed 22 health/well-being outcomes in 2022 across six domains, including physical and cognitive health, health behaviors, mental health, subjective well-being, social well-being, and pro-social or altruistic behaviors. We adjusted pre-baseline covariates, including prior outcome values in 2020.

Participation in the points-program was associated with more fruit and vegetable intake (risk ratio = 1.30; 95% confidence interval: 1.14, 1.49; p < 0.001), more participation in learning or cultural groups (1.45; 1.19, 1.78; p < 0.001)/community gathering places (1.58; 1.22, 1.85; p < 0.001)/neighborhood associations (1.25; 1.13, 1.38; p < 0.001), and a greater number of friends seen within a month (1.31: 1.10, 1.50; p < 0.001), after accounting for multiple testing via Bonferroni correction. Although we observed more modest and mixed evidence for other outcomes, we identified no harmful effects of the incentive program on any of the outcomes we assessed.

The points-program has the potential to promote not only the immediate outcomes it targets but also other domains of health and well-being outcomes through increased social interaction and healthy behaviors.