The Impact of Alternative Incentive Schemes on Completion of Health Risk Assessments

PURPOSE: The biggest challenge for corporate wellness initiatives is low rates of employee participation. We test whether a behavioral economic approach to incentive design (i. e. , a lottery) is more effective than a direct economic payment of equivalent monetary value (i. e. , a grocery gift certificate) in encouraging employees to complete health risk assessments (HRAs). DESIGN: Employees were assigned to one of three arms. Assignment to a treatment arm versus the nontreatment arm was determined by management. Assignment to an arm among those eligible for treatment was randomized by office. SETTING: A large health care management and information technology consulting company. PATIENTS: A total of 1299 employees across 14 offices participated. INTERVENTION: All employees were eligible to receive 25 for completing the HRA. Those in the lottery condition were assigned to teams of four to eight people and, conditional on HRA completion, were entered into a lottery with a prize of 100 (expected value, 25) and a bonus value of an additional 25 if 80% of team members participated. Those in the grocery gift certificate condition who completed an HRA received a 25 grocery gift certificate. Those in the comparison condition received no additional incentive. MEASURES: HRA completion rates. ANALYSIS: Logistic regression analysis. RESULTS: HRA completion rates were significantly higher among participations in the lottery incentive condition (64%) than in both the grocery gift certificate condition (44%) and the comparison condition (40%). Effects were larger for lower-income employees, as indicated by a significant interaction between income and the lottery incentive. CONCLUSION: Lottery incentives that incorporate regret aversion and social pressure can provide higher impact for the same amount of money as simple economic incentives.