Health Cash Incentives for Poor People Debated

Affirmative side says they may reduce health inequality; negative side doubts significant benefit
By Rick Ansorge
HealthDay Reporter

WEDNESDAY, July 9 (HealthDay News) -- Should disadvantaged people be paid to take care of their health? That's the question of a "Head to Head" debate published online July 8 in BMJ.

Presenting the affirmative case, Richard Cookson, Ph.D., of the University of York in the United Kingdom, cites cash-incentive programs in developing countries that have helped improve health measures among impoverished residents. Although he cautions that cash-transfer programs are not a panacea, and emphasizes the need for "careful piloting and evaluation of cost effectiveness in well-designed studies," he concludes that they have the potential to improve population health, reduce health inequality, and possibly reduce the tax burden associated with costly medical interventions.

Presenting the negative case, Jennie Popay, Ph.D., of Lancaster University in Lancaster, U.K., argues that cash-incentive programs stigmatize poor people by separating them from the general population and marking them as "irresponsible" and "unwilling to behave in socially acceptable ways." Although she allows that such programs may improve simple behaviors such as increasing the number of doctor visits, she states that they have failed to improve complex behaviors such poor diet and smoking, and argues that a deeper solution is needed to improve health measures in disadvantaged populations.

In any accompanying feature article, freelance writer Karen McColl reports on Opportunity NYC, a new, privately funded program that offers cash payments to poor New York City residents for maintaining subsidized health insurance and getting annual medical and dental checkups. "Both critics and enthusiasts of this approach will be watching New York, as one of the world's richest cities experiments with a program of conditional cash transfers to break the poverty cycle," McColl states.

Abstract - Cookson
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Abstract - Popay
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