The Impact of Alternative Incentive Schemes on Completion of Health Risk Assessments

Haisley et al. (2012)
George Loewenstein,T Pellathy,Emily Haisley,Kevin Volpp
Summary by 
Mark Egan

The authors looked at different ways to encourage employees (N=1299, 81% female, mean age 41) at a health care management and IT consulting company to complete Health Risk Assessments (HRAs); specifically examining whether a lottery is more effective than a direct payment of equivalent monetary value (i.e. a gift certificate). There was a control group in addition to these two treatment arms.The authors cite inspiration from the Dutch postal code lottery for their design, which incorporates regret aversion. In their lottery, employees were divided into teams of 4-8 and one team was randomly selected as the winner each week. Each member of the winning team who had completed the HRA prior to the time of the drawing would win $100. If at least 80% of the members of the team completed the HRA, the prize would increase to $125.Results showed significantly higher HRA completion for the lottery group (64%) than the gift certificate group (44%) and the control (40%). Effects were larger for lower-income employees.

Purpose.The biggest challenge for corporate wellness initiatives is low rates of employee participation. We test whether a behavioral economic approach to incentive design (i.e., a lottery) is more effective than a direct economic payment of equivalent monetary value (i.e., a grocery gift certificate) in encouraging employees to complete health risk assessments (HRAs).Design.Employees were assigned to one of three arms. Assignment to a treatment arm versus the nontreatment arm was determined by management. Assignment to an arm among those eligible for treatment was randomized by office.Setting.A large health care management and information technology consulting company.Patients.A total of 1299 employees across 14 offices participated.Intervention.All employees were eligible to receive $25 for completing the HRA. Those in the lottery condition were assigned to teams of four to eight people and, conditional on HRA completion, were entered into a lottery with a prize of $100 (expected value, $25) and a bonus value of an additional $25 if 80% of team members participated. Those in the grocery gift certificate condition who completed an HRA received a $25 grocery gift certificate. Those in the comparison condition received no additional incentive.Measures.HRA completion rates.Analysis.Logistic regression analysis.Results.HRA completion rates were significantly higher among participations in the lottery incentive condition (64%) than in both the grocery gift certificate condition (44%) and the comparison condition (40%). Effects were larger for lower-income employees, as indicated by a significant interaction between income and the lottery incentive.Conclusion.Lottery incentives that incorporate regret aversion and social pressure can provide higher impact for the same amount of money as simple economic incentives.