Skip to main content

Financial incentives for exercise and medical care costs


Physical inactivity has become a public health priority in many developed countries to address large disease burdens from noncommunicable diseases and the associated financial costs. Policymakers are interested in incentive programs that use behavioral science insights to address the lack of exercise in citizens. However, as considerable resources are required for incentive payments and administration, determining the cost-effectiveness or return on investment of disseminating such programs is critical. This study evaluates the economic effects and costs of an incentive-based exercise program using data derived from the project conducted in six Japanese municipalities between 2014 and 2015, analyzing medical care costs as the project’s outcomes. By using a doubly robust difference-in-difference estimator, we found that the average treatment effects of the reduction in medical care costs due to the project were particularly evident for women, yielding a decline of 58,000 JPY. In total, the project was expected to save short-term medical care costs by 465 million JPY. Similarly, age-specific analysis showed medical care cost reductions of 56,200 JPY for those in their 60 s and 58,400 JPY for those in their 70 s, and these figures resulted in saving short-term medical care costs by 450 million JPY in total. With operational budgeted costs of 180 million JPY, including the fee for incentive payments, the short-term economic benefits of the project were significant and positive.

This is a preview of subscription content, access via your institution.

Fig. 1

The data source for this graph is WPP participant data

Fig. 2

The data source for this graph is WPP participant data

Fig. 3

The data source for this graph is WPP participant data

Fig. 4

The data source for this graph is WPP participant data

Data availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.


  1. In most cities, gift certificates could only be used in that city as local gift certificates. In contrast, gift certificates issued in certain cities could be used across the country. Local gift certificates could be redeemed at specific shopping districts and partner stores in each city. In some municipalities, participants could redeem a gift certificate with a premium of 500 JPY for every 3,000 JPY. These gift certificates were not redeemable outside the city, thereby ensuring that the local gift certificate money was spent in the same city.


  1. Ding, D., Lawson, K. D., Kolbe-Alexander, T. L., Finkelstein, E. A., Katzmarzyk, P. T., van Mechelen, W., & Pratt, M. (2016). The economic burden of physical inactivity: A global analysis of major non-communicable diseases. The Lancet, 388(10051), 1311–1324.

    Article  Google Scholar 

  2. Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2018). Worldwide trends in insufficient physical activity from 2001 to 2016: A pooled analysis of 358 population-based surveys with 1·9 million participants. The Lancet Global Health, 6(10), e1077–e1086.

    Article  Google Scholar 

  3. World Health Organization. (2018). The global health observatory (GHO) data: Prevalence of insufficient physical activity, Retrieved September 14, 2022, from

  4. Ikeda, N., Inoue, M., Iso, H., Ikeda, S., Satoh, T., Noda, M., Mizoue, T., Imano, H., Saito, E., & Katanoda, K. (2012). Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in japan: A comparative risk assessment. PLoS Medicine, 9(1), e1001160.

    Article  Google Scholar 

  5. Finkelstein, E. A., Bilger, M., & Baid, D. (2019). Effectiveness and cost-effectiveness of incentives as a tool for prevention of non-communicable diseases: A systematic review. Social Science and Medicine, 232, 340–350.

    Article  Google Scholar 

  6. Mitchell, M. S., Goodman, J. M., Alter, D. A., John, L. K., Oh, P. I., Pakosh, M. T., & Faulkner, G. E. (2013). Financial incentives for exercise adherence in adults: Systematic review and meta-analysis. American Journal of Preventive Medicine, 45(5), 658–667.

    Article  Google Scholar 

  7. Ries, N. (2012). Financial incentives for weight loss and healthy behaviours. Healthcare Policy, 7(3), 23–28.

    Article  Google Scholar 

  8. Muller-Riemenschneider, F., Reinhold, T., & Willich, S. N. (2008). Cost-effectiveness of interventions promoting physical activity. British Journal of Sports Medicine, 43(1), 70–76.

    Article  Google Scholar 

  9. Anokye, N., Fox-Rushby, J., Sanghera, S., Cook, D. G., Limb, E., Furness, C., Kerry, S. M., Victor, C. R., Iliffe, S., & Ussher, M. (2018). Short-term and long-term cost-effectiveness of a pedometer-based exercise intervention in primary care: A within-trial analysis and beyond-trial modelling. British Medical Journal Open, 8(10), e021978.

    Article  Google Scholar 

  10. Anokye, N., Mansfield, L., Kay, T., Sanghera, S., Lewin, A., & Fox-Rushby, J. (2018). The effectiveness and cost-effectiveness of a complex community sport intervention to increase physical activity: An interrupted time series design. British Medical Journal Open, 8(12), e024132.

    Article  Google Scholar 

  11. Kang, S. W., & Xiang, X. (2017). Physical activity and health services utilization and costs among U.S. Adults. Preventive Medicine, 96, 101–105.

    Article  Google Scholar 

  12. Okamoto, S., Kamimura, K., Shiraishi, K., Sumita, K., Komamura, K., Tsukao, A., Chijiki, S., & Kuno, S. (2021). Daily steps and healthcare costs in japanese communities. Scientific Reports.

    Article  Google Scholar 

  13. Sari, N. (2009). Physical inactivity and its impact on healthcare utilization. Health Economics, 18(8), 885–901.

    Article  Google Scholar 

  14. Chevan, J., & Roberts, D. E. (2014). No short-term savings in health care expenditures for physically active adults. Preventive Medicine, 63, 1–5.

    Article  Google Scholar 

  15. Warburton, D. E. R., Crystal Whitney, N., & Bredin, S. S. D. (2006). Health benefits of physical activity: The evidence. Canadian Medical Association Journal, 174(6), 801–809.

    Article  Google Scholar 

  16. Sant’Anna, P.H.C. & Zhao, J. (2020). Doubly robust difference-in-differences estimators. Journal of Econometrics, 219(1), 101–122.

    Article  Google Scholar 

  17. Roth, J., Sant’Anna, P. H., Bilinski, A., & Poe, J. (2022). What’s trending in difference-in-differences A synthesis of the recent econometrics literature. arXiv Preprint 2201. 01194.

    Article  Google Scholar 

  18. Heckman, J. J., Ichimura, H., & Todd, P. E. (1997). Matching as an econometric evaluation estimator: Evidence from evaluating a job training programme. The Review of Economic Studies, 64(4), 605–654.

    Article  Google Scholar 

  19. Heckman, J., Ichimura, H., Smith, J., & Todd, P. (1998). Characterizing selection bias using experimental data. Econometrica, 66(5), 1017–1098.

    Article  Google Scholar 

  20. Abadie, A. (2005). Semiparametric difference-in-differences estimators. The Review of Economic Studies, 72(1), 1–19.

    Article  Google Scholar 

  21. Robins, J. M., Rotnitzky, A., & Zhao, L. P. (1994). Estimation of regression coefficients when some regressors are not always observed. Journal of the American Statistical Association, 89(427), 846–866.

    Article  Google Scholar 

  22. Bang, H., & Robins, J. M. (2005). Doubly robust estimation in missing data and causal inference models. Biometrics, 61(4), 962–973.

    Article  Google Scholar 

  23. Hoshino, T. (2007). Doubly robust-type estimation for covariate adjustment in latent variable modeling. Psychometrika, 72(4), 535–549.

    Article  Google Scholar 

  24. Scharfstein, D. O., Rotnitzky, A., & Robins, J. M. (1999). Adjusting for nonignorable drop-out using semiparametric nonresponse models. Journal of the American Statistical Association, 94(448), 1096–1120.

    Article  Google Scholar 

  25. Wooldridge, J. M. (2007). Inverse probability weighted estimation for general missing data problems. Journal of Econometrics, 141(2), 1281–1301.

    Article  Google Scholar 

  26. Rios-Avila, F., Sant'Anna, P., & Naqvi, S.A.A., DRDID: Stata module for the estimation of doubly robust difference-in-difference models, in Statistical Software Components S458977. 2021, Boston College Department of Economics. p. revised 19 Jul 2022.

  27. Farooqui, M. A., Tan, Y. T., Bilger, M., & Finkelstein, E. A. (2014). Effects of financial incentives on motivating physical activity among older adults: Results from a discrete choice experiment. BMC Public Health, 14, 141.

    Article  Google Scholar 

  28. Okamoto, S., Komamura, K., Tanabe, K., Yokoyama, N., Tsukao, A., Chjiki, S., & Kuno, S. (2017). Who opts out of a project for health promotion with incentives?: Empirical researchon the effect of rewards to motivate persistence. Japanese Journal of Public Health [Nihon Kosyu Eisei Zassi], 64(8), 412–421.

    Article  Google Scholar 

  29. Charness, G., & Gneezy, U. (2009). Incentives to exercise. Econometrica, 77(3), 909–931.

    Article  Google Scholar 

  30. Finkelstein, E. A., Brown, D. S., Brown, D. R., & Buchner, D. M. (2008). A randomized study of financial incentives to increase physical activity among sedentary older adults. Preventive Medicine, 47(2), 182–187.

    Article  Google Scholar 

Download references


We greatly appreciate helpful comments from Prof. Mamoru Miyamoto (Kanto Gakuin University) at JEPA2021 The 20th International Conference of the Japan Economic Policy Association. We also greatly appreciate helpful comments and support from Dr. Kai Tanabe (University of Tsukuba), Dr. Noriko Yokoyama (Nihon Wellness Sports University), and Dr. Shoko Chijiki (Tsukuba Wellness Research Inc.).


“Multi-Municipal Collaborative Large Scale Wellness Point Project” was part of the following research projects sponsored by the ministries. (1) Study of ICT Health Model (Prevention Medicine) for Establishment of Local Community Activation Model*, (2) IoT Service Creation Support Project (Challenge Project for Fee-Based IoT Health Services with Incentives)*, (3) Research and Study for Typification of Prevention Projects such as Health Points with a view to Institutionalizing Incentivized Health Programs**, (4) Study on How to Create Incentives to Promote Sports and Exercise Lifestyles among a Large Number of People, Including Those Who are Indifferent to Health Promotion***, (5) Study of a Sports Exercise Program with Incentives to Promote Behavioural Change and Improve Outcomes among Those Who are Indifferent to Health Promotion***, and (6) Project to Promote Regional Vitalization through Sports (Creation of a Healthy and Long-Lived Society through Sports)****. Ministries had no involvement in the study design, collection, analysis, and interpretation of data, writing of the report, and in the decision to submit the article for publication.* Supported by the Ministry of Internal Affairs and Communications. ** Supported by the Ministry of Health, Labour, and Welfare *** Supported by the Ministry of Education, Culture, Sports, Science, and Technology. **** Supported by the Japan Sports Agency.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Kazuki Kamimura.

Ethics declarations

Conflict of interest

We declare no conflicts of interest associated with this study.

Ethical approval

This study was approved by the Institutional Review Board of the Graduate School of Comprehensive Human Sciences of the University of Tsukuba (No. Tai26-40).

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 37 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kamimura, K., Okamoto, S., Shiraishi, K. et al. Financial incentives for exercise and medical care costs. IJEPS 17, 95–116 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Incentivized programs
  • Quasi-experimental approach
  • Physical activity
  • Doubly robust difference-in-difference estimator

JEL Classification

  • I12
  • I18