Pay for...Health??

Is it ethical to pay patients to improve their health?

We've heard of pay-for-performance, in which doctors are paid based on the clinical outcomes of their patients. P4P assumes that while doctors are motivated by seeing sick patients become better, they are also motivated financially and will perform procedures simply for financial gain.

But should we pay patients to take care of their health? Under healthcare reform, 32M patients will be enrolled in the system. Insurance companies can not deny coverage no matter how unprofitable these patients are. Therefore, it's in everyone's best interest for these patients to get better. However, many patients take poor care of themselves by eating unhealthy foods, not exercising, not taking their medications, etc. This increases their utilization of expensive healthcare services, and causes premiums of other members to rise to cover the healthcare costs of the unhealthy patients. Therefore, if we can incentivize these patients using money, we may lower the costs of the healthcare system for everyone.

I struggle with this issue because I believe people should be motivated to take care of their own health for their own sake. If they need to be paid to improve their health, are they really worth saving?

Do the ends justify the means?