Health Test Gift Cards -- Brilliant or Bribery?

Oct. 22, 2008— -- Colonoscopies, pap smears, mammograms. People need them and yet, few are keen on getting them.

To encourage such screening, public health advocates are increasingly offering some sweeteners that put Mary Poppins' little spoonful of sugar to shame, even if it makes some doctors a little leery.

First, there are the parties. In a mammogram party, women get food, massages and other pampering before submitting their bosoms to the painful smashing of a mammography machine. Then, for both sexes, there's the colonoscopy party -- a similar event minus, thankfully, the food.

In one Colorado town last year, the local hospital escorted colonoscopy patients in a limo and provided water in martini glasses, according to the Rocky Mountain News.

This year, the trend has moved to gift cards and giveaways to induce people to go to the doctor. The CDC recently offered gift cards to influential speakers in the gay community to increase awareness of HIV/AIDS.

In Illinois, the state health department enticed parents to get health screenings for their children by giving away $50 gas gift cards to the first 1,000 parents who signed up.

Despite all the extra patients getting screenings, many doctors are ambivalent about the practice of health giveaways.

Health Not Always a One-Time Transaction

In an ideal world, many doctors would prefer to build a relationship with patients to offer better treatment, something that may not happen with an in-and-out health screening initiative.

"I do think that patients mostly benefit from having a regular physician rather than a doc in the box," said Dr. Anthony Elias, the medical director of the Breast Cancer and Sarcoma Programs at the University of Colorado Cancer Center in Aurora, Colo.

"However, providing free or reduced-rate mammograms or colonoscopies might increase the number who get these tests and these screens typically do not benefit as much from physician continuity," he said.

Other doctors are concerned about what happens when a person attends a screening, gets a diagnosis, and doesn't have a regular doctor for support and treatment.

But What Happens After Cancer Diagnosis?

"There may frequently be downstream consequences for the patient if the test is positive," said Dr. Anthony Smith, professor and chief of the division of urology at the University of New Mexico School of Medicine in Albuquerque.

Some public health officials take the screenings a step further to address this concern. At the Illinois Department of Public Health this year, the department expanded free breast cancer and cervical cancer screenings to include all uninsured women and provide low-cost treatment.

"It was hard to tell a woman, 'we're going to give you free screenings, but if you do have cancer, sorry. We know you can't pay for treatment, but here's your diagnosis,'" said Melaney Arnold, communications manager for the Illinois Department of Public Health.

To give a little push for women to sign up for the free screenings, the IDPH has trained beauty technicians in salons across the state to educate women, offer the screenings and let them know about the $25 gift card donated by Walgreens when the woman shows up for her appointment.

"Beauty salons are places where women feel comfortable talking about everything," said Y'lonn Parker, owner of the Y'lonn Salon in Chicago, and a participant in the screening program, called Beautiful Inside and Out.

Health Care in Beauty Salons

"A lot of women are like, 'yeah, I know I have breasts and I need to get checked for it,' but they're leery," said Parker. "It's real common for us to be talking to one of the ladies, some asking, 'did it hurt?' And we have literature posted on the wall about how they can get free screening."

"Well, $25 in this economy, it's a nice little benefit for your own health and we could possibly change a person's life, or save a woman's life," said Parker.

"If a small screening gift certificate or a screening party is a way to continue the dialogue, that cancer screening can save lives, then I support that strategy," said Dr. A. William Blackstock, chair of radiation oncology at Wake Forest University Comprehensive Cancer Center in Winston-Salem, N.C.

Yet, while some doctors applaud the initiative, others wonder who profits as more gift card programs surface. Even charitable donations often have some sort of reward for publicity or expected revenue in return.

"I have not seen this, but I would be very suspicious that there is a conflict of interest among those offering screening," said Dr. Peter C. Albertsen, a professor and program director of urology at the University of Connecticut Health Center in Farmington, Conn. "I do not suspect it is totally altruistic, someone is making money," he said.

The Kansas Health Policy Authority knows exactly who will be making money, or saving money, to be more precise: the state will.

"We made a number of changes to our state employee health plan in the last few years ... with the health and wellness and personal responsibility side of the ledger," said Marcia Nielsen, PhD MPH and executive director of the Kansas Health Policy Authority, which insures all state employees.

"You can have policies that are kind of punitive in nature, if you're thinking of carrot and sticks, they're the sticks," said Nielsen. "We wanted to start with the carrots."

That carrot included $50 gift cards to employees who fill out an online health assessment tool. While that tool helped the employees, it also helped the state determine which services would be most effective to offer.

"The year of the carrot is now being followed up with the year of the stick," joked Nielsen. The "stick" policy is to charge smokers more for health care to encourage people to stop smoking and save the state from paying for cancer treatment.

"We have a health system that is backward in some ways," said Nielsen. "We charge people all kinds of money for things we'd encourage them to do to save lives, and that's a hassle in the first place."