Seminar 8: Incentives that create healthy behaviour

The latest in C3’s series of International Breakfast Seminars was given by Dr Craig Nossel on 21 July 2011, on Discovery Health’s Vitality programme: Incentives that create healthy behaviour and show health and financial results.

• Slides from the event are available here >> (pdf is 5MB)
• A full report of the event is available here >>

Behaviour change can have a very substantial impact on health, and the ‘billion dollar question’ is how you get people to change. Incentives may encourage us to alter our behaviour, as they help to overcome the tendency we have not to think ahead, and to be over-optimistic about our own chances of not getting ill.

Discovery Health is an insurance company that has been running a programme of incentives known as ‘Vitality’ for 12 years in South Africa. Vitality is now being introduced in the United Kingdom (with PruHealth), the US (a new joint venture with Humana) and China (with Ping An).

Initially, each Vitality member takes a health assessment, and the individual’s ‘Vitality Age’ is then calculated, which shows years-of-life-lost based on certain risk factors, such as body mass index, cholesterol level and physical activity. A Vitality Age that is more than actual age helps people to think differently about their health and understand how their lifestyles are affecting their health.  Each is then given a ‘personal pathway’ for health, relevant to individual health status, and appropriate rewards are offered for taking appropriate steps (e.g. rewards for taking more exercise). The wide range of incentives for taking part give real value to being in the programme, including discounted flights with BA and local budget airline Kulula, cinema tickets and healthy food discounts.

Vitality is working with academics to research the impact of the programme on 948,000 people in 2003–7.

• Study 1: Vitality engagement is related to lower healthcare costs. This study looked at hospital admissions for engaged and not-engaged people – and found lower costs across the board for those who were engaged.
• Study 2: Vitality engagement reduces the cost of managing NCDs. For example, the risk-adjusted hospital cost for cancer of an engaged member is 90 per cent that of a non-engaged person, and for mental health just 79 per cent.
• Study 3: Fitter people spend less time in hospital and incur lower costs. Their return to work is also quicker.
• Longitudinal study: Vitality engagement was tracked over five years, comparing those who became active during that time with those who stayed inactive. Initially, about 50% of those in the programme were inactive, and this fell to about 30%. Hospital costs fell by 6% per member over five years among those who moved from inactive to active. In addition, among those who were initially already active, staying active lowered costs by 8% – and if they got more active, costs were 9% lower.

Craig presented the HealthyFood^TM project in detail.

• It is a partnership with Pick n Pay (the largest retailer in South Africa). Vitality members get a 10% discount on 10,000 healthy foods, increasing to 25% if members take the Vitality Age assessment (this led to a 600% increase in the number of people taking the assessment).
• A nutrition panel used dietary guidelines to select which foods would count as healthy food items:  of 61,000 products at Pick n Pay, 10,000 were classified as healthy. The company is working with the MRC in the UK on a similar scheme.
• Each Vitality member gets a healthy food card, swiped to access the discounts; the discount is then paid back into the individual’s bank account at the end of the month;
• The HealthyFood proportion of the average basket is increasing.

Discovery is also running broader health-promotion initiatives, including a Healthy Active Kids Report Card 2010 ; the Vitality Schools Program; information packs on obesity for GPs (about 5,000 GPs have already been trained in child obesity); a ‘Healthiest City’ project comparing data from South African cities on obesity, blood pressure, smoking, etc.; and, most recently, a Healthy Company Index, to help companies understand the health of their employees.

The discussion included questions on:

• the demographics of those in Vitality;
• sharing of risk and reward between Discovery/Vitality and partner companies;
• the sustainability of the initiative;
• whether Vitality would consider using small penalties as incentives rather than rewards (to which the answer was ‘no’ – it is not the approach the initiative has chosen to take);
• what is it about the South African context that has meant that this project was initiated there.