Financial incentives for exercise and medical care costs
Tóm tắt
Physical inactivity has become a public health priority in many developed countries to address large disease burdens from noncommunicable diseases and the associated financial costs. Policymakers are interested in incentive programs that use behavioral science insights to address the lack of exercise in citizens. However, as considerable resources are required for incentive payments and administration, determining the cost-effectiveness or return on investment of disseminating such programs is critical. This study evaluates the economic effects and costs of an incentive-based exercise program using data derived from the project conducted in six Japanese municipalities between 2014 and 2015, analyzing medical care costs as the project’s outcomes. By using a doubly robust difference-in-difference estimator, we found that the average treatment effects of the reduction in medical care costs due to the project were particularly evident for women, yielding a decline of 58,000 JPY. In total, the project was expected to save short-term medical care costs by 465 million JPY. Similarly, age-specific analysis showed medical care cost reductions of 56,200 JPY for those in their 60 s and 58,400 JPY for those in their 70 s, and these figures resulted in saving short-term medical care costs by 450 million JPY in total. With operational budgeted costs of 180 million JPY, including the fee for incentive payments, the short-term economic benefits of the project were significant and positive.
Tài liệu tham khảo
Ding, D., Lawson, K. D., Kolbe-Alexander, T. L., Finkelstein, E. A., Katzmarzyk, P. T., van Mechelen, W., & Pratt, M. (2016). The economic burden of physical inactivity: A global analysis of major non-communicable diseases. The Lancet, 388(10051), 1311–1324. https://doi.org/10.1016/S0140-6736(16)30383-X
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2018). Worldwide trends in insufficient physical activity from 2001 to 2016: A pooled analysis of 358 population-based surveys with 1·9 million participants. The Lancet Global Health, 6(10), e1077–e1086. https://doi.org/10.1016/S2214-109X(18)30357-7
World Health Organization. (2018). The global health observatory (GHO) data: Prevalence of insufficient physical activity, Retrieved September 14, 2022, from https://apps.who.int/gho/data/view.main.2463
Ikeda, N., Inoue, M., Iso, H., Ikeda, S., Satoh, T., Noda, M., Mizoue, T., Imano, H., Saito, E., & Katanoda, K. (2012). Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in japan: A comparative risk assessment. PLoS Medicine, 9(1), e1001160. https://doi.org/10.1371/journal.pmed.1001160
Finkelstein, E. A., Bilger, M., & Baid, D. (2019). Effectiveness and cost-effectiveness of incentives as a tool for prevention of non-communicable diseases: A systematic review. Social Science and Medicine, 232, 340–350. https://doi.org/10.1016/j.socscimed.2019.05.018
Mitchell, M. S., Goodman, J. M., Alter, D. A., John, L. K., Oh, P. I., Pakosh, M. T., & Faulkner, G. E. (2013). Financial incentives for exercise adherence in adults: Systematic review and meta-analysis. American Journal of Preventive Medicine, 45(5), 658–667. https://doi.org/10.1016/j.amepre.2013.06.017
Ries, N. (2012). Financial incentives for weight loss and healthy behaviours. Healthcare Policy, 7(3), 23–28. https://doi.org/10.12927/hcpol.2013.22780
Muller-Riemenschneider, F., Reinhold, T., & Willich, S. N. (2008). Cost-effectiveness of interventions promoting physical activity. British Journal of Sports Medicine, 43(1), 70–76. https://doi.org/10.1136/bjsm.2008.053728
Anokye, N., Fox-Rushby, J., Sanghera, S., Cook, D. G., Limb, E., Furness, C., Kerry, S. M., Victor, C. R., Iliffe, S., & Ussher, M. (2018). Short-term and long-term cost-effectiveness of a pedometer-based exercise intervention in primary care: A within-trial analysis and beyond-trial modelling. British Medical Journal Open, 8(10), e021978. https://doi.org/10.1136/bmjopen-2018-021978
Anokye, N., Mansfield, L., Kay, T., Sanghera, S., Lewin, A., & Fox-Rushby, J. (2018). The effectiveness and cost-effectiveness of a complex community sport intervention to increase physical activity: An interrupted time series design. British Medical Journal Open, 8(12), e024132. https://doi.org/10.1136/bmjopen-2018-024132
Kang, S. W., & Xiang, X. (2017). Physical activity and health services utilization and costs among U.S. Adults. Preventive Medicine, 96, 101–105. https://doi.org/10.1016/j.ypmed.2016.12.043
Okamoto, S., Kamimura, K., Shiraishi, K., Sumita, K., Komamura, K., Tsukao, A., Chijiki, S., & Kuno, S. (2021). Daily steps and healthcare costs in japanese communities. Scientific Reports. https://doi.org/10.1038/s41598-021-94553-2
Sari, N. (2009). Physical inactivity and its impact on healthcare utilization. Health Economics, 18(8), 885–901. https://doi.org/10.1002/hec.1408
Chevan, J., & Roberts, D. E. (2014). No short-term savings in health care expenditures for physically active adults. Preventive Medicine, 63, 1–5. https://doi.org/10.1016/j.ypmed.2014.02.020
Warburton, D. E. R., Crystal Whitney, N., & Bredin, S. S. D. (2006). Health benefits of physical activity: The evidence. Canadian Medical Association Journal, 174(6), 801–809. https://doi.org/10.1503/cmaj.051351
Sant’Anna, P.H.C. & Zhao, J. (2020). Doubly robust difference-in-differences estimators. Journal of Econometrics, 219(1), 101–122. https://doi.org/10.1016/j.jeconom.2020.06.003
Roth, J., Sant’Anna, P. H., Bilinski, A., & Poe, J. (2022). What’s trending in difference-in-differences A synthesis of the recent econometrics literature. arXiv Preprint 2201. 01194. https://doi.org/10.48550/arXiv.2201.01194
Heckman, J. J., Ichimura, H., & Todd, P. E. (1997). Matching as an econometric evaluation estimator: Evidence from evaluating a job training programme. The Review of Economic Studies, 64(4), 605–654. https://doi.org/10.2307/2971733
Heckman, J., Ichimura, H., Smith, J., & Todd, P. (1998). Characterizing selection bias using experimental data. Econometrica, 66(5), 1017–1098. https://doi.org/10.2307/2999630
Abadie, A. (2005). Semiparametric difference-in-differences estimators. The Review of Economic Studies, 72(1), 1–19. https://doi.org/10.1111/0034-6527.00321
Robins, J. M., Rotnitzky, A., & Zhao, L. P. (1994). Estimation of regression coefficients when some regressors are not always observed. Journal of the American Statistical Association, 89(427), 846–866. https://doi.org/10.1080/01621459.1994.10476818
Bang, H., & Robins, J. M. (2005). Doubly robust estimation in missing data and causal inference models. Biometrics, 61(4), 962–973. https://doi.org/10.1111/j.1541-0420.2005.00377.x
Hoshino, T. (2007). Doubly robust-type estimation for covariate adjustment in latent variable modeling. Psychometrika, 72(4), 535–549. https://doi.org/10.1007/s11336-007-9007-2
Scharfstein, D. O., Rotnitzky, A., & Robins, J. M. (1999). Adjusting for nonignorable drop-out using semiparametric nonresponse models. Journal of the American Statistical Association, 94(448), 1096–1120. https://doi.org/10.1080/01621459.1999.10473862
Wooldridge, J. M. (2007). Inverse probability weighted estimation for general missing data problems. Journal of Econometrics, 141(2), 1281–1301. https://doi.org/10.1016/j.jeconom.2007.02.002
Rios-Avila, F., Sant'Anna, P., & Naqvi, S.A.A., DRDID: Stata module for the estimation of doubly robust difference-in-difference models, in Statistical Software Components S458977. 2021, Boston College Department of Economics. p. revised 19 Jul 2022.
Farooqui, M. A., Tan, Y. T., Bilger, M., & Finkelstein, E. A. (2014). Effects of financial incentives on motivating physical activity among older adults: Results from a discrete choice experiment. BMC Public Health, 14, 141. https://doi.org/10.1186/1471-2458-14-141
Okamoto, S., Komamura, K., Tanabe, K., Yokoyama, N., Tsukao, A., Chjiki, S., & Kuno, S. (2017). Who opts out of a project for health promotion with incentives?: Empirical researchon the effect of rewards to motivate persistence. Japanese Journal of Public Health [Nihon Kosyu Eisei Zassi], 64(8), 412–421. https://doi.org/10.11236/jph.64.8_412
Charness, G., & Gneezy, U. (2009). Incentives to exercise. Econometrica, 77(3), 909–931. https://doi.org/10.3982/ECTA7416
Finkelstein, E. A., Brown, D. S., Brown, D. R., & Buchner, D. M. (2008). A randomized study of financial incentives to increase physical activity among sedentary older adults. Preventive Medicine, 47(2), 182–187. https://doi.org/10.1016/j.socscimed.2019.05.018