Incentives to be healthy - is it all about the benjamins?

Here are some of the incentives my medical school offers its students, faculty, researchers, staff & support people to stay healthy, as delievered in an email today.

The summer is a great time to get healthy. BCM has some exciting programs with nice financial incentives to help you get through Houston's sizzling months and come out in better shape:

Weight Watchers at Work: If you sign up for convenient Weight Watchers at Work classes during the summer, BCM will pay for 20% of your enrollment fee. It's normally $180 for the 15-week session, but now BCM will pay $36 and you pay only $144...

24 Hour Fitness: BCM has a special corporate rate with 24 Hour Fitness, and the gyms have reduced their family add-on fee to only $49...

Smoking cessation: Our EAP provider... will be providing four-session courses for BCM employees and students and their significant others... Each participant is encouraged to bring a buddy... The fee for the course is $125 per person. After completing all four classes, each participant (both BCM folks and their buddies) will be reimbursed $100.

It is funny to see this line at the end of the smoking cessation deal, in case you didn't realize it: This is a very good deal.

Do financial incentives change people's behavior? On the surface, and intuitively, the answer seems yes.

But the Douglas Rushkoff of a neat book called Get Back in the Box (about work & life in today's internet-based renaissance) disagrees. He frames the ineptness of the financial carrot stick in the world of work: "The more frequently you reinforce "good" behavior with cash, the more you disconnect employees from their own experience of the work itself... [shifting focus] from the task and onto the reward."

Is that a bad thing per se, or ineffective? Well, no. The writer himself backs off a bit from his strong assertion by writing there are people who need money desperately or want money in order to fill a psychological emptiness (think Maslow's hierarchy and about how the need of love & belonging is below self-actualization), and for these people money is most ideal motivator.

However, I think for an educated guy or girl who wants to quit smoking for health, even moral reasons, money is not as good a motivator to quit as making the process of quitting fun (which is the book's point: intrinsic rewards drive a person to work harder at something because that work is approached as play), painless or full of meaning.

In fact I know people who quit by spending more money -- a clear disincentive in the conventional sense -- because quitting simply meant so much to them.

And more obviously, kids are more interested in fun. For the average obese kid, what would compel him to lose weight, being given $500 to exercise 3 times a week for a year or making the experience fun? I think kids, who aren't as entrenched in the real world where money means so much, would rather have fun. In fact, a professor at my school says his dream is to combine elements of a gym and video games to get obese kids skinnier.

These are just some thoughts and anecdotes. I'll post more when I find some scientific evidence to back up these positions.