incentivising healthy behaviour - ippr · promotion techniques are often the most effective...

Presenting to: IPPR

Date: 4 May 2006

Shaun Matisonn

CEO, PruHealth

INCENTIVISING HEALTHY BEHAVIOUR

2

OVERVIEW

1. Public Health Background

2. Improving Health

3. The PruHealth Approach

4. PruHealth Evidence

5. Conclusions

The aim of this presentation is to provide information, not advice.

PruHealth is a trading name of Prudential Health Limited which is registered in England and Wales. Registered

office at Laurence Pountney Hill, London, EC4R 0HH. Authorised and regulated by the Financial Services Authority.

PUBLIC HEALTH BACKGROUND

The impact of avoidable disease

4

PUBLIC HEALTH BACKGROUND -

CHRONIC DISEASE

Source: WHO (2005) Preventing Chronic Disease: A Vital Investment

Projected main causes of burden of disease (DALYs)

by World Bank Income group, all ages, 2005

Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies

Chronic diseases

Injuries

Low income Lower middle

income

Upper middle

incomeHigh income World

World Bank income group

Age-standardized DALYs100 000

5

PROBABILITY OF 15 YEAR SURVIVAL WITHOUT CORONARY ARTERY DISEASE,STROKE OR DIABETES

Source: Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in middle-aged British men. Archives of Internal Medicine (1998), SG Wannamethee et al.


IMPACT OF LIFESTYLE

6

Small changes can make a big difference - Evidence from EPIC, University of Cambridge:

� Low levels of activity vs. complete inactivity can increase longevity by about

three years

� Salt reductions of less than a teaspoon a day can halve a person’s chances of

getting high blood pressure

� 50g extra vitamin C - roughly an apple a day - can cut the risk of dying early

from any cause by 20%


INCREMENTAL BEHAVIOUR CHANGE

7

“Please indicate how much you agree or disagree with each of the statements that I read out. Firstly...Every day I am concerned about keeping fit and healthy”

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Total Male Female 16-24 25-34 35-44 45-54 55-64 65+

1986 2004

Source: 'Changing Lives'/'Changing Lives in Europe', nVision/Taylor Nelson Sofres, 2004Base: 1000-2000 adults 16+, UK


AWARENESS OF HEALTH ISSUES

8

Source: Employee Benefits - Healthcare Research 2004

Base: 2004 (320 employers) 2003 (381 employers)

Provision of corporate health services

0% 10% 20% 30% 40% 50% 60% 70%

On-site GP

Health screening

On-site occupational

health

EAP

Workstation audits

PMI

% of employers surveyed

2004

2003


EMPLOYER PROVISION OF HEALTH-RELATED SERVICES

9

Barriers to exercise Barriers to exercise Barriers to exercise Barriers to exercise

9.9%

4.5%

6.9%

12.2%

13.6%

16.9%

17.5%

24.4%

30.0%

39.3%

6.4%

4.1%

8.2%

12.7%

15.3%

16.3%

22.0%

26.7%

33.9%

48.8%

3.7%

Other

Sports related injury

There are no plannedactivities that I can join

Cost of equipment prohibitsdoing more exercise

I do not have time becauseof social commitments

Lack of convenient exercisefacilities/ area to exercise

I do not have anybody toexercise with

I am not physically able to doexercise

Cost prohibits doing moreexercise

I do not have time becauseof family commitments

I do not have time becauseof work commitments

I find it difficult to motivatemyself

Why don't you do as much exercise asyou think you should?

Why don't you do as exercise as youwould like

Source: Deloitte Health of the Nation Report, 2006


AVAILABILITY OF FACILITIES

10

PUBLIC HEALTH BACKGROUND

� The problem of avoidable illness is recognised and relatively well

understood

� The required change in behaviour is clear, and need not be

fundamental - incremental changes can have a significant impact

� Many individuals have the right knowledge and intentions

� Employers are starting to invest more in health and wellness

� Most people have access to the right facilities

So why does it appear so difficult to change behaviour?

IMPROVING HEALTH

Lessons from Economics and Psychology

12

Intention Healthy behaviour

Adapted from Health Promotion: Planning and Strategies, Tones and Green, 2004

The Health Action Model

EnvironmentSkillsKnowledge

Personality

Social norms

Motivation

Beliefs

Confirmation

Relapse

IMPROVING HEALTH

13

IMPROVING HEALTH -

BELIEFS

“Belief in personal susceptibility to a negative event”

‘It can happen to me’

Adapted from Health Promotion: Planning and Strategies, Tones and Green, 2004

“Belief that the recommended measure will not entail too heavy a cost”

‘I don’t have to sacrifice much to do that’

14

Over-optimism

US gym study: people on contracts ended up

paying an average of $17 per visit, even when

a $10 per visit rate was available

Focus on the present

� Choice of £10 in 30 days or £11 in 31 days:

people wait for £11.

� Choice of £10 today or £11 tomorrow: some

will take £10 today.

� Conclusion: we are happy to wait for delayed

gratification . . . but not this month

IMPROVING HEALTH -

BELIEFS

15

Focus on the presentPeople place more value on immediate

pleasures than on future health issues

Over-optimism

People underestimate the risk of an unhealthy

lifestyle now . . .

. . . and tend to overestimate their ability to

improve in future

IMPROVING HEALTH -

BELIEFS

16

� Cross-sectional studies confirm that information is an important determinant of demand

for health-related goods (eg. Viscusi (1990), Journal of Political Economy)

� Advice from doctors can have a substantial and significant impact on behaviour (eg. for

smoking, Kottke (1998), JAMA)

� People tend to underestimate their own health risks relative to those they think others

face (eg. on smoking see Schoenbaum (1997), American Journal of Public Health)

� Almost a quarter of UK adults claim that cost prohibits them from doing as much exercise

as they would like (Deloitte, 2006)

� US data: the price of junk food can account for 12% of the deteriorating trend in weight

outcomes from 1984 to 1999 (Chou et al (2004), Journal of Health Economics)

� Although used infrequently, financial incentives used in conjunction with other health

promotion techniques are often the most effective interventions (Weingarten et al (2002),

BMJ)

IMPROVING HEALTH -

SAMPLE OF THE EVIDENCE

PRUHEALTH APPROACH

Consumer engaged healthcare

18

THE PRUHEALTH PRODUCT

19

Most you would be willing to pay per month for a gym membership

Source: Research commissioned by PruHealth from Market Measures, May 2004

PRICE BARRIERS TO HEALTH AND FITNESS CLUBS

THE PRUHEALTH PRODUCT –

REMOVING BARRIERS

20


21


MAKE IT EASIER TO LIVE A HEALTHY LIFE

22


23

Silver

50%

of unclaimed premiums

Gold

75%


Platinum

100%


Members receive a percentage of their unclaimed premiums to offset against next years premium according to their Vitality status.

Bronze

25%



REWARDING INDIVIDUALS

24


PRUHEALTH EVIDENCE

26

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

(Aug)

Membership

Source: Discovery data, 2004

PRUHEALTH EVIDENCE -

DISCOVERY DATA

27

VariableVariable South Africa OverallSouth Africa Overall South Africa High Income Population*

South Africa High Income Population* U.K. Overall U.K. Overall

Household Income (GBP at PPP)

Household Income (GBP at PPP) £ 20,479£ 20,479 £ 46,834£ 46,834 £ 24,592£ 24,592

Possession of college / university degree

Possession of college / university degree 14.8%14.8% 66.7%66.7% 24.8%24.8%

Access to the internetAccess to the internet8.3%8.3% 39.5%39.5% 58%58%

Own / rent a cellular telephone

Own / rent a cellular telephone 32.0%32.0% 94.6%94.6% 75%75%

Own a home computerOwn a home computer11.1%11.1% 46.8%46.8% 54%54%

Households with two or more motor vehicles

Households with two or more motor vehicles

Access to digital satellite / digital cable TV at home

Access to digital satellite / digital cable TV at home

24.3%24.3%

4.7%4.7%

60.2%60.2%

23.1%23.1%

27%27%

44%44%

Note: *High income population refers to the top 20% of earners; **Household income is the average of the top 20% of households other data has been used for households earning £500 or more per week; Most data points are estimates based on the most recently available informationSource: AMPS 2000/03; Statistics SA; World bank; UK National Statistics -Household survey 2002; UK Department of Education

UK High Income Population**

UK High Income Population**

£ 60,284£ 60,284

(not available)(not available)

71%71%

92%92%

81%81%

51%51%

53%53%

PRUHEALTH EVIDENCE –

DISCOVERY DATA

28

MARKET SHARE OF SA MEDICAL INSURANCE AMONGST TOP 200 COMPANIES

Source: Financial Mail Top 200 Companies Survey

National Medical Plan

Ingwe

Sizwe

Fedhealth

Protector

Bankmed

Liberty Life

Spectramed

Bonitas

Other

Self -insured

Discovery


DISCOVERY DATA

29

IMPACT ON PREVENTATIVE CARE



IMPACT ON BEHAVIOUR

30

IMPACT ON PREVENTATIVE CARE



IMPACT ON BEHAVIOUR

31

33% REDUCTION IN OBESITY AFTER SECOND TEST


BREAKDOWN OF BODY MASS INDEX [FIRST AND SECOND TESTS FOR VITALITY MEMBERS]


IMPACT ON BEHAVIOUR

32

49% MORE PEOPLE WITH ‘GOOD’ OR ‘EXCELLENT’ FITNESS

BREAKDOWN OF STEP TEST RESULTS [FIRST AND SECOND TESTS FOR VITALITY MEMBERS]


IMPACT ON BEHAVIOUR


33

Salary

Source: Discovery data, 1993 - 2004; Statistics South Africa

DISCOVERY MEDICAL TREND Vs. INDUSTRY AND INFLATION

Industry

Discovery


IMPACT ON OUTCOMES

CONCLUSIONS

35

CONCLUSIONS

� Social norms, attitudes, and ingrained habits create the context for any behavioural change

� Knowledge is critical, but needs to be personalised

� Measurement, feedback and a sense of achievement is important

� Price is an important determinant of usage

� Financial incentives in the right places can generate significant changes in behaviour

� All of these elements need to be taken together to generate sustainable behaviour change

� But within this, financial incentives can play a fundamental role in converting intentions to habitual actions

INCENTIVISING HEALTHY BEHAVIOUR

Presenting to: IPPR

Date: 4 May 2006

Shaun Matisonn

CEO, PruHealth

incentivising healthy behaviour - ippr · promotion techniques are often the most effective...

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