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.
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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.
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.
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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.
Conflict of interest
We declare no conflicts of interest associated with this study.
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).
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Kamimura, K., Okamoto, S., Shiraishi, K. et al. Financial incentives for exercise and medical care costs. IJEPS 17, 95–116 (2023). https://doi.org/10.1007/s42495-022-00093-6
- Incentivized programs
- Quasi-experimental approach
- Physical activity
- Doubly robust difference-in-difference estimator