Controlling health care costs in the military: The case for using financial incentives to improve beneficiary personal health indicators Neal A. Naito a, b, ⁎, Stephen T. Higgins c, d a Medical Corps, United States Navy (Retired), USA b Pacific Institute for Research and Evaluation, USA c Department of Psychiatry, University of Vermont, USA d Department of Psychology, University of Vermont, USA abstract article info Available online 2 July 2012 Keywords: Military personnel Behavior and behavior mechanisms Motivation Preventive health services Objective. To provide insight on the feasibility and utility of implementing a broad based incentive pro- gram for health within the Military Health System (MHS). Method. Published studies, articles, and information on the use of financial incentives in the military set- ting and to promote healthy behaviors were reviewed. Results. Health care costs in the MHS have more than doubled over the past decade. The high prevalence of modifiable risk behaviors such as tobacco abuse, physical inactivity and obesity and their associated chron- ic diseases are accounting for a significant percentage of the growth. One evidence-based approach to address this issue would be the implementation of a broad based incentive program for health whereby all MHS ben- eficiaries would be eligible to receive some type of financial remuneration for meeting positive personal health metrics (e.g. not smoking or a normal body mass index). This approach if designed appropriately has the potential to have a high level of acceptance within the current beneficiary population since financial incentives are already used widely in the military to help meet overall manpower requirements. Conclusion. The use of a MHS wide financial incentives program to instill healthy behaviors in beneficia- ries’ may be an effective means to curb rising healthcare cost. © 2012 Elsevier Inc. All rights reserved. Introduction Health care costs in the Military Health System (MHS) have more than doubled over the past decade (Department of Defense (DoD), 2011). The high prevalence of modifiable risk behaviors such as to- bacco abuse and obesity and their associated chronic diseases ac- counts for a significant percentage of the rise and are projected to continue to do so in the future (Military Health System, 2012). In- deed, a cost analysis involving 4.3 million beneficiaries (service mem- bers, dependents, and retirees) under age 65 yrs enrolled in the TRICARE Prime health option in 2006 estimated that the DoD was spending $2.1 billion per year for medical care related to tobacco use, excess weight and obesity, and high alcohol consumption (Dall et al., 2007). Another $965 million dollars in additional non-medical annual costs were incurred due to such factors as work absenteeism and training of replacements. As in the civilian healthcare sector, many beneficiaries fail to make the personal lifestyle and treatment choices that could help the MHS achieve its Quadruple Aim of efficient per capita costs, high quality experience of care, optimal population health, and maximal military readiness (Military Health System, 2012). While the military has strongly embraced the strategy of health promotion over the past several decades, the results have been mixed. Military personnel have access to a full range of screening, diagnosis, and treatment programs for lifestyle related medical con- ditions such as substance abuse and obesity. Often these programs can be done during work hours and are free. Available are pharmaco- logical and non-pharmacological therapies for tobacco cessation, alcohol abuse/addiction screening and treatment programs, and routine body composition analysis linked with evidence based weight loss programs. Yet, young adults in the military continue to drink and smoke more heavi- ly than their civilian peers (Bray et al., 2009). The effect of substance abuse on military readiness is significant resulting in decreased personnel fit- ness and increased musculoskeletal injuries. Also, once out of the military, health disparities between separated or retired enlisted personnel and of- ficers worsen (Edwards, 2008). Thus, there is a need within the MHS to consider alternative approaches to encouraging beneficiaries to adopt healthier lifestyles. Preventive Medicine 55 (2012) S113–S115 ⁎ Corresponding author at: 11720 Beltsville Drive, Suite 900 Calverton, MD 20705- 3102. Fax: +1 301 755 2799. E-mail address: naiton3@gmail.com (N.A. Naito). 0091-7435/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2012.06.022 Contents lists available at SciVerse ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed