Last week, it was announced that drug addicts in England are to be given shopping vouchers for complying with treatment programmes. In this week’s BMJ, two experts debate whether it is acceptable for people to be paid to adhere to medication.
Rewarding patients to cooperate is not new, argues Tom Burns, a senior psychiatrist at Warneford Hospital in Oxford. Most mental health practitioners reward patients for “healthy” behaviour and financial incentives are no different.
People who criticise money for medicines emphasise the “exploitation of impoverished patients” and worries about how patients would spend the money. But whether a payment represents a just reward or immoral exploitation depends on the circumstances not the transaction, he writes.
Far from being unethical and unacceptable, he believes that money for medication is a refreshingly honest acknowledgement of the different perspectives of the two parties involved.
Rather than a way to manipulate patients to do what we want them to do it provides a model of respectful exchange, he concludes.
But Joanne Shaw, Chairman of Ask About Medicines, believes that payment is not the way to solve the high costs of non-adherence to medication. Paying for adherence, whether in the form of cash or non-financial benefits, creates perverse incentives and undermines the therapeutic alliance between patients and doctors that is needed for long term health care, she writes.
As soon as money is introduced into the equation, we have created the conditions for fraud, so our first problem is one of policing, she says. Paying people to take medicines also sends a signal that they need to be compensated for doing something that is not inherently in their own interests.
Convincing people to accept treatment when they are reluctant to do so is a genuine problem, but paying for adherence, however seductive it may appear, will never be the way to solve it, she concludes.
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