In “Game of life: Paying patients to take medication”, CanWest News Services reporter Misty Harris writes:

“In preliminary testing of the lottery system with people taking the blood-thinner warfarin, the rate of patients missing a dose dropped to just three percent from 23 per cent” an effect the national medical director of Aetna Pharmacy, Dr. Edmund Pezalla attributes to having a concrete goal.

Each time a patient takes prescribed tablets on schedule their names will be entered into a draw that gives them a one-in-five chance of winning a $10 daily prize and a one-in-100 chance of winning $100 over the course of the 180 day pilot program.

“It’s not the amount of money…that’s important to people, but rather the fact that there is an activity….It keeps people engaged,” he says.

And there is the key: Keeping people engaged in their own health and health care.

This isn’t an entirely new approach. Similar efforts have shown benefit whether it is paying patients to lose weight or quit smoking.

In the UK, new programs are evolving that pay patients pre-arranged amounts to help keep them out of hospital. In Lord Darzi’s plan for the NHS, all patients with long-term conditions will have personal care plans and five thousand of those with long-term conditions will pilot personal care budgets.

However, if the move toward incentives for patients to engage in their own care or the move toward funding “personal care budgets” pick up steam, what happens to other patients who are dutifully attempting to lead healthy lives? Is their reward simply the potential for a healthy life? Is this “equal” treatment of patients to pay some for specific efforts but not for others? How do we as Canadians with a sense of equality for all justify “payments” to patients in some circumstances but not others?

Conversely, if attempts to engage patients through such activities as medication lotteries and government payments for personal care budgets that help avoid costly hospital and ER visits are seen as a positive move forward by government, then why would there be attempts to prevent patients from funding their own care in greater amounts as they deem necessary?

Is it fair and egalitarian that some patients will benefit from additional government funding for their specific care and health management while others are not equally empowered?