Harnessing financial incentives for health promotion: A scoping review of prevention programs implemented in upper-middle and high-income countries

The recent demographic and epidemiological trends, coupled with escalating healthcare costs, necessitate innovative strategies for health promotion and disease prevention. Financial incentives have gained attention as potential tools to encourage desirable health behaviors. This study aims to map real-world programs employing financial incentives for health promotion implemented by public institutions or insurance companies in upper-middle and high-income countries, focusing on program characteristics, incentive structures and available impact assessments. Using a scoping review methodology, we identified 27 programs spanning tax-funded and insurance-based healthcare systems. Most programs targeted primary prevention, incentivizing behaviors such as vaccination and physical activity, with several multidimensional initiatives addressing multiple health behaviors simultaneously. Incentives ranged from cash payments to vouchers, often linked to measurable outcomes like vaccination completion or activity levels monitored through wearables. The collected evidence suggests these programs can positively influence targeted behaviors. At the same time, solid impact evaluations were lacking for a relevant number of programs in scope, cost-effectiveness estimates remain limited, and the long-term sustainability of behavior change after incentives are removed or reduced calls for additional real-world investigation. This study was the first to analyze the characteristics of real-world implementations of health promotion programs based on financial incentives, complementing existing evidence from experimental studies. Insights from this review can inform the design of more effective and possibly sustainable programs, emphasizing the role of financial incentives in fostering personal responsibility for health while supporting the sustainability of healthcare systems.