why  we    

shouldn’t  gamify    

the  necessities    

of  life    

 

 

 

 

 

 

 

 

 

noraly  schiet  |  3952630  

Joost  Raessens  |  game  studies    

master  new  media  &  digital  culture  |  university  of  utrecht  

final  version  15.11.2012  

 

  2  

abstract

The   debate   on   gamification   is   currently   at   its   top.   Several   authors   with   different  

backgrounds   have   strong   positive   or   negative   points   of   view   regarding   gamification.  

Only   few   have   a   nuanced   opinion.   In   this   paper,   I   do   not   argue   for   or   against  

gamification,   but   propose   a   new   way   of   entering   the   discussion:   by   thinking   about  

ethical   questions   related   to   the   application   of   gamification.   Where   should   we   set  

borders?  When  is  it  not  desirable  to  apply  gamification?  I  will  argue  that  this  is  at  the  

two  basic  levels  of  human  needs,  as  to  be  found  in  the  hierarchy  of  needs  by  Abraham  

Maslow.  By  relating  to  a  case  study  on  Menzis’  program   ‘SamenGezond’,   I  will   try   to  

set  borders  and  give  a  start  for  a  new  approach  in  the  debate  on  gamification.  

Keywords

gamification,  menzis,  samengezond,  ethics,  hierarchy  of  needs,  health  

  3  

introduction

 

There  is  an  emotion  that  comes  up  with  every  new  form  or  application  of  technology;  

fear.  About  a  year  ago,  Gary  Shteyngart  published  A  Super  Sad  True  Love  Story,  a  book  

about  dystopian  New  York  in  the  near  future,  where  media  and  reputation  dominate  

life  more   than   ever.   Everyone   has   an   apparät,   a   device   that   could   be   described   as   a  

super   advanced   iPhone   that   allows   you   to   factcheck,   broadcast,   watch   others  

broadcastings,   communicate   etcetera.   While   everyone   is   constantly   checking   their  

statuses  and  being  extremely  aware  of  their  reputation,  the  world  unravels  in  war  and  

crisis,  under  the  influence  of  the  media;  people  are  fully  dominated  and  overruled  by  

technology  and  media.  The  scary  thing  is  that  this  story  is  futuristic,  but  nonetheless  

not  so  unthinkable;  it  is  just  an  exaggeration  of  what  we  already  do  in  daily  life  now.  

Another  example  that  shows  fear  about  the  development  of  current  technology  use  is  

Black   Mirror.   This   is   a   series   produced   by   BBC,   consisting   of   three   episodes.   The  

second  episode  relates  explicitly  to  gamification,  a  topic  that  I’d  like  to  address  in  this  

paper.  The  main  character,  Bing,  needs  to  cycle  on  a  stationary  bike  in  front  of  a  huge  

screen   displaying   games   or   ridiculous   television   programmes,   in   order   to   collect  

merits.  Merits  count  as  currency;   they  are  virtual,  and  the  only  way   to  buy   food  and  

other  things  you  need.  One  is  constantly  confronted  with  his  achievements  since  there  

are   leaderboards   showing  how  many  merits  everyone   is   collecting;   it   is  made   into  ai  

competition.  

Those  two  examples  are  only  two  of  many  that  pose  use  of  new  technology  and  

more  specifically  gamification   in  a  negative  way,   trying   to  make  us  aware  of  dangers  

that  possibly  lie  ahead.  Only  right  after  I  had  seen  and  read  the  series  and  book,  I  read  

about   a   new   campaign   launched   by  Dutch   health   insurance   company  Menzis.   They  

introduced   a   new   plan   called   ‘SamenGezond’,  which   allows   you   to   collect   points   by  

doing   things   they   consider   to   be   ‘good’;   the   points   collected   can   be   exchanged   for  

financial  discounts  on  for  example  your   insurance  premium  or  articles   in  the  Menzis  

web  shop.  This  struck  me;  this  is  one  of  the  first  examples  of  gamification  that  has  the  

possibility  of   influencing  ones   life   so  directly.   I  wondered  what   I   thought   about   this  

development;  is  it  good?  Can  it  maybe  better  ones  life?  Or  is  it  the  other  way  around,  

and   something   that   should   be   seriously   reconsidered?   Are   there   other   examples   of  

similar  plans  and  strategies  using  gamification  in  such  a  direct  relation  to  basic  human  

needs?  

  4  

It   is  mostly   the   last  part   that   fascinates  me;   the   idea   that   the  gamification   is  

applied  to  the  basic  elements  of  human  life.  This  is  a  point  that  is  up  till  now  relatively  

uncovered   in   the   debate   on   gamification.   Reading   Jane  McGonigal’s   book  Reality   is  

Broken   made   me   wonder   even   more   what   this   is   all   about;   should   gamification   be  

applied  to  the  necessities  of  life?  Is  it  desirable?  McGonigal  is  extremely  positive  about  

the   influence   games   might   have   not   only   on   our   daily   lives,   but   also   in   greater  

perspective.  On  the  other  hand,  we  have  Ian  Bogost  with  an  extremely  negative  view,  

and  Gabe  Zichermann  being  very  positive  about  the  applications  of  gamification  from  

a   marketing   perspective.   This   debate   is   often   sketched   in   a   very   opposed   way;  

gamification  is  either  good  or  bad.  I  am  not  so  much  interested  in  choosing  sides,  but  

rather   dive   into   ethical   questions   concerning   gamification,   triggered   by   Menzis’  

campaign;  this  case  creates  the  feeling  that  a  border  is  crossed,  but  why?  Up  till  now,  

there  has  been  relatively  little  written  about  the  ethical  borders  of  gamification.  I  will  

try  to  get  this  discussion  started.  

First,  I  will  sketch  my  position  in  the  heated  debate  on  gamification  and  what  I  

would   like   to  achieve  with   this  essay.  Then   I  will   explain  where   I   think   the   (ethical)  

borders   lie,   based   on   two   larger   arguments,   theoretically   supported   by   referring   to  

several  authors  and  their  theories.  I  will  refer  to  the  hierarchy  of  needs  developed  by  

Abraham  Maslow;  this  is  a  model  that  shows  how  human  needs  work  and  how  these  

gradually   move   up   in   his   model,   through   different   layers.   This,   together   with   the  

exploration   of   the   gamification   debate,   will   hopefully   give   an   answer   to   what   I   am  

wondering  about;  should  one  apply  gamification  to  the  necessities  of  life?  

 

  5  

chapter 1

sketching the debate on gamification

 

Gamification  is  relatively  new.  The  term  was  coined  first   in  2008,  but  was  to  be  used  

widespread   from   around   2010   (Deterding   et   al   2011:   9).   Since   then,   several   theorists  

have  written   about   gamification   in   different  ways.   There   are   some   key   authors   that  

have  given  their  (explicit)  points  of  view,  all  coming  from  a  very  different  tradition.  To  

make  it  clear,  I  have  placed  them  on  a  continuum;  see  figure  1  below.  

At  the  left  side  of  the  continuum,  I  have  placed  two  authors,  Jane  McGonical  and  Gabe  

Zichermann,  who  both  have  a  positive  view  on  gamification.  On  the  far  right,  there  is  

Ian  Bogost,  who  explicitly  speaks  against  gamification,  calling  it  bullshit  (Bogost  2011).  

Sebastian  Deterding   is   somewhere   in  between;  he   sees  clever  and  useful  possibilities  

for  gamification,  but  does  not  agree  with  the  way  it  is  mostly  implemented  nowadays.  

 

However,  they  all  have  a  very  different  background,  which  makes  the  discussion  quite  

polarized,   it  seems  thought   in  black-­‐and-­‐white  terms  with   little  room  for  nuances  or  

input.  Ian  Bogost  is  a  game  designer  and  argues  mainly  against  marketeers.  His  biggest  

issue  with  gamification  is  that  games  are  being  misused  for  marketing  related  issues;  

he  feels  that  it  is  only  used  to  make  a  bigger  profit  and  this  ruins  the  so  to  say  ‘magical  

concept’  of  a  game;  

 

figure  1:  continuum.  Views  on  gamification  from  positive  to  negative.  

  6  

“More  specifically,  gamification  is  marketing  bullshit,   invented  by  consultants  

as   a   means   to   capture   the   wild,   coveted   beast   that   is   videogames   and   to  

domesticate   it   for  use   in   the   grey,   hopeless  wasteland  of   big  business,  where  

bullshit  already  reigns  anyway.”  (Bogost  2011)  

 

He   is,   least   to   say,   quite   negative   when   it   comes   to   gamification.   He   is   the   very  

opposite  of  Gabe  Zichermann,  an  advocate  of  gamification  coming  from  the  marketing  

world.   He   is   a   marketing   consultant   and   entrepreneur   and   has   written   quite   some  

books  on  the  application  of  gamification  from  a  commercial  point  of  view.  He  foresees  

that   ‘by   2015,   every   company   will   have   a   Chief   Engagement   Officer,   and  

gamification/playful   experience   design   will   ascend   to   a   trusted   and   established  

profession  the  world  over.’  (Zichermann  2010)  He  focuses  on  the  force  of  leaderboards,  

points  and  badges  a   lot  (Zichermann  2010;  something  that  horrifies  Ian  Bogost,  since  

(not  only  according  to  Bogost)  a  game  consists  of  a  lot  more.    

  From  a  whole  different  perspective,  Jane  McGonical  comes  in.  In  her  first  and  

up  till  now  only  book  Reality  Is  Broken:  Why  Games  Make  us  Better  and  How  they  Can  

Change  the  World  (2011)  McGonigal  argues  that  games  can  really  contribute  to  a  better  

world   if   everyone   is   involved   in   massive   multiplayer   games   aimed   on   making   this  

world   a   better   place.   McGonigal   is   a   game   developer   originally,   but   takes   a   more  

sociological  and  very  idealistic  point  of  view.  One  of  the  games  she  developed  herself  

and  that  she  regards  a  useful   tool   for  everyone  who’s   facing  a   tough  challenge  or   for  

example  –which  was  her  reason  to  create  this  game-­‐  illness  is  called  SuperBetter.  This  

allows   you   to   set   your   own   rules   and   guidelines   in   order   to   get   better   or   face   your  

challenge,  in  the  format  of  a  game.  

 

All   these  points  of  view  are  quite  biased.  All   three  are  very  much  embedded   in   their  

own   field   of   research,   without   having  much   of   an   eye   for   other   opinions.   They   are  

focused  on  preaching   their   ideas  and   they  practise  what   they  preach  –  which  means  

they   miss   quite   a   lot.   The   only   one   who   is   somewhere   in   between   is   Sebastian  

Deterding.   In   an   excellent   Google   Tech   Talk   he   gave   in   January   2011,   Deterding  

explains  what   is   wrong  with  most   applications   of   gamification,   and  what   should   be  

done   in  order   to  make   it  better.   In   short,  he  defines  what   a   good  game   should   look  

like,  applies   this   to  gamification  and   thereby  shows  what   is  done  wrong  most  of   the  

times.  I  will  refer  to  Deterding  later  on,  since  I  strongly  agree  with  some  of  his  points.  

  7  

 

I  am  not  one  hundred  percent  for  or  against  gamification,  yet  I  think  there  need  to  be  

set   some  ethical  borders;   something   that  up   till  now  has  not  been  under  discussion.  

Instead  of  how  gamification  should  be  applied  well  in  the  form  of  rules  and  mastery  for  

example,  I  am  operating  on  another  plane.  Using  the   ‘SamenGezond’  plan  by  Menzis  

as   a   starting  point,   I  will   explain  how   I   think   ethics   should  be   regarded  when  using  

gamification.    

 

 

 

  8  

chapter 2

setting ethical guidelines

 

First,  I  will  explain  how  SamenGezond  actually  works.  In  appendix  #1  you  can  find  the  

news   article   that   announces   the   plan.   SamenGezond   was   introduced   on   the   17th   of  

September,   2012,   by   the  Dutch   health   insurance   company  Menzis.   It   is   not   the   first  

health   insurance   company   to   introduce   (aspects   of)   gamification;   the   UnitedHealth  

Group   (UHG)   for   example   has  written   a  whole   program   dedicated   to   games,   where  

they  are   ‘taking  existing  health-­‐related  processes  and/or  activities  and   infusing   them  

with  gaming  elements  in  order  to  boost  user  engagement,  such  as  establishing  rewards  

systems  for  meeting  goals,  incentivizing  certain  behaviours,  and/or  adding  an  element  

of  competition.’   (Plourde  2012:   18).  The  same  counts  for  Menzis’  program.  When  you  

subscribe  for   ‘SamenGezond’,  you  can  collect  points  for   ‘good’  or   ‘healthy’  behaviour.  

You  can  earn  these  points  in  different  ways:  by  filling  in  a  list  of  questions  about  your  

lifestyle   or   exercise   behaviour;   register   as   a   donor;   quit   smoking;   take   care   of   ill   or  

dying   family   or   friends   for   at   least   eight   hours   a   week   (in   Dutch   ‘mantelzorg’);  

membership  at  a  gym.  Other  possibilities  to  earn  points  are  still  being  added.  You  can  

earn   a  maximum  of   5000  points.  Only   a   small  part  of   this   can  be  used   for   getting   a  

discount  on  your  insurance  premium;  the  rest  has  to  be  spent  in  the  Menzis  web  shop.  

This  web  shop  is  filled  with   ‘healthy’  and  ‘good’  articles  like  charity  donations,  sports  

articles,   wellness   arrangements   and   cookbooks   filled   with   healthy   recipes.   Menzis  

introduced   this   program  because   they  want   to   stimulate   their   customers   to   become  

more  active  and  aware  concerning  their  own  health.  The  idea  is,  ‘the  healthier  you  live,  

the   more   points   you   earn’,   which   should   result   in   a   healthy   society,   according   to  

Menzis1.  

 

In  the  next  part,  I  will  argue  in  two  paragraphs  why  Menzis  has  applied  gamification  in  

a  wrong  way,  addressing  several  aspects  of  the  program  and  referring  to  the  hierarchy  

of  needs  by  Abraham  Maslow.  

                                                                                                                 1  Waarom  heeft  Menzis  SamenGezond  geintroduceerd?  (Why  did  Menzis  introduce  SamenGezond?)  In:  Veelgestelde  vragen  (FAQ),  Menzis.nl.  Last  viewed  on  12.9.2012.  <http://www.menzis.nl/web/Consumenten/Klantenservice/SpaarprogrammaSamenGezond/VeelgesteldeVragenSamenGezond.htm#waarom_heeft_menzis_samengezond_geïntroduceerd?>  

  9  

2.1 the necessities of life

 

I  will  first  give  an  outline  of  what  are  considered  the  basic  needs,  or  the  necessities  of  

life.   According   to  Abraham  Maslow,   human  needs   can   be   categorized   in   a   pyramid,  

with  the  more  basic  needs  at  the  bottom.  See  figure  2;

 

  The  very  basic  needs  are  purely  physiological;  breathing,  food,  water,  sex,  sleep,  

homeostasis   and   excretion.   Homeostasis   means   ‘the   body’s   automatic   efforts   to  

maintain  a  constant,  normal  state  of  the  blood  stream’  (Maslow  1943:  372);  essential  for  

being  alive.  Those  physiological  needs  need  to  be  fulfilled  before  anything  else.  Other  

needs   always   come   in   second   place   when   one   of   those   needs   is   not   satisfied.   As  

Maslow  puts   it,   someone   ‘who   is   lacking   food,   safety,   love,   and   esteem,  would  most  

probably  hunger  for  food  more  strongly  than  for  anything  else.’  (Maslow  1943:  373)  A  

person  would  always  strive  to  keep  its  physiological  needs  satisfied.  When  this  is  done  

so,   one   goes   up   one   step   in   the   pyramid   seen   in   figure   1;  when   this   basic   hunger   is  

fulfilled,   it   moves   to   the   background   of   what   is   important   at   that   moment   for   the  

individual.    

figure  2:  Maslow’s  hierarchy  of  needs  

  10  

  The  second  layer  in  the  pyramid  refers  to  safety  needs.  Those  cannot  exist  for  

an   individual   when   the   physiological   needs   aren’t   satisfied,   but   nonetheless   ‘the  

organism  may  equally  well  be  wholly  dominated  by  them.’  (Maslow  1943:  376).  Maslow  

explains   this  mainly  referring  to  children,  since  they  express   themselves  quite  visibly  

when   feeling   unsafe.   Feeling   safe   can   be   referred   to   on   several   levels.   Health   is   an  

important  one;  we  all  know  the  unsafe  feeling  you  get  when  you  are  ill  and  you  cannot  

rely  on  your  body.  Also,  it  is  very  important  that  you  feel  safe  in  the  place  you  live,  and  

within  the  family  you  are  born.  In  this  range  of  needs  it  is  easy  to  see  how  the  needs  

cannot   be   seen   totally   separated;   one   usually   prefers   familiar   things   over   unfamiliar  

things   and  many  people   use   for   example   religion   to   order   their  world   as   to  make   it  

understandable  and  thus  ‘safe’  –  they  have  the  feeling  they  know  what  they  are  dealing  

with  (Maslow  1943:  379).  Religion,  however,   is  thus  something  that  cannot  be  related  

to  a  specific  layer  in  the  pyramid.  

  The  third  layer  in  the  hierarchy  of  needs  is  related  to  love.  Human  beings  need  

love   and   affection,   from  both   friends   and   family.   Sexual   intimacy   is   also   involved   in  

this   layer.   As   you   see,   sex   is   also   placed   in   the   basic,   physiological   needs;   it   is  

important   to  distinguish  between  the  physiological  need   for  sex  and  the   love-­‐related  

need  for  sexual  intimacy.  The  human  is  a  social  creature  that  longs  for  love  and  lives  in  

groups;   love   can   therefore   not   be   underestimated.   (Maslow   1943:   381)   Without  

affection  and  the  feeling  of  belonging,  one  cannot  desire  the  needs  placed  higher  in  the  

pyramid;  esteem  and  self-­‐actualization.    

  Esteem  and   self-­‐actualization   form   the   top  of   the  pyramid.  Esteem  comes   first  

and  can  be  distinguished  into  two  sets  of  needs:  

 

“These   are,   first,   the   desire   for   strength,   for   achievement,   for   adequacy,   for  

confidence   in   the   face   of   the   world,   and   for   independence   and   freedom.  

Secondly,   we   have   what   we   may   call   the   desire   for   reputation   or   prestige  

(defining   it   as   respect   or   esteem   from   other   people),   recognition,   attention,  

importance  or  appreciation.”  (Maslow  1943:  381-­‐382)  

 

By   this  needs,  one  becomes  self-­‐confident,   feeling  comfortable,  useful  and  respected.  

Others   can   suppress   those   feelings,   too;   this   affects   other   levels   of   need,   since  

diminishing  ones  confidence  can  make  the  other  feel  unsafe  and  unloved.    

  Then,  the  very  top  of  the  pyramid;  this  is  the  need  for  self-­‐actualization.  When  

all   the   other   needs   are   fulfilled,   you   might   still   feel   restless;   some   additional   need  

  11  

needs  to  be  satisfied.    This  is  something  that  can  vary  enormously,  depending  on  the  

individual.   It   is   the   striving   for   becoming   what   one   really   wants   to;   for   example   a  

painter,  a  poet,  or  a  mother  (Maslow  1943:  382).    

 

Wrapping   it  up,   there  are   roughly   five  needs   that,   in   this  order,  have   to  be  satisfied:  

physiological  needs,  safety  needs,  love  needs  or  belonging,  needs  related  to  esteem  and  

last   but   not   least,   self-­‐actualization.   I   regard   those,   in   order   of   importance,   the  

necessities  of  life.  However,  Maslow  writes  that  the  order  of  the  pyramid  might  not  be  

as   strict   as   posed;   in   some   cases,   for   example   self-­‐esteem   and   love  might   be   turned  

around.  Also,  it  is  not  the  case  that  one  layer  of  the  pyramid  needs  to  be  100%  fulfilled  

in  order  to  step  up;  ‘a  more  realistic  description  of  the  hierarchy  would  be  in  terms  of  

decreasing   percentages   of   satisfaction   as   we   go   up   the   hierarchy   of   prepotency.’  

(Maslow  1943:  386-­‐388)  Nonetheless  the  pyramid  cannot,  for  example,  be  reverted.  

 

I  would  like  to  emphasize  the  two  basic,  bottom  layers  of  the  pyramid.  These  have  to  

be  satisfied  almost  to  the  fullest  in  order  to  lead  a  very  basic  and  relatively  stable  life.  

The   upper   three   layers   are   also   dependent   on   each   other,   but   can   in   some   cases   be  

more  or   less   intertwined,   as  Maslow  describes   in  his   list   of   nuances   and   exceptions.  

The  bottom  two  (physiological  and  safety  needs)  nonetheless  can  absolutely  dominate  

ones  life  when  not  satisfied;    

 

“Again,   as   in   the   hungry  man,   we   find   that   the   dominating   goal   is   a   strong  

determinant  not  only  of  his  current  world-­‐outlook  and  philosophy  but  also  of  

his  philosophy  of   the   future.  Practically   everything   looks   less   important   than  

safety,  (even  sometimes  the  physiological  needs  which  being  satisfied,  are  now  

underestimated).   A   man,   in   this   state,   if   it   is   extreme   enough   and   chronic  

enough,  may  be  characterized  as  living  almost  for  safety  alone.”  (Maslow  1943:  

376)  

 

Gamification   should   not   be   connected   to   those   two   basic   layers.   Those   are   to   be  

fulfilled   coming   from   intrinsic   motivation,   instead   of   being   pushed   by   extrinsic  

motivation.   Successful   gamification   is   mostly   applied   to   the   upper   layers   of   the  

hierarchy;  many  very  good  examples  of  gamification  are  for  example  to  be  found  in  the  

  12  

educational  branch  or  when  it  comes  to  to-­‐do-­‐lists2.  A  very  good  example  of  a  gamified  

type  of  learning  is  codeacademy.  This  is  an  online  learning  school  based  on  a  website  

which  learns  you  programming  language  –  but  gamified.  When  you  enter  the  website,  

a  command  window  opens  and  asks  you  to  spell  your  name,  starting  and  ending  with  

quotes.   After   you’ve   done   this,   you   get   several   other   tasks;   playfully,   you’ll   get   to  

understand  what  you’re  learning.  Of  course,  you  can  also  learn  this  by  studying  a  book  

which  provides  you  with  all  the  codes;  yet,  this  gameful  design  is  what  makes  it  much  

more  fun  and  engaging,  motivating  you  to  keep  on  going.  It  is  exactly  what  Deterding  

(et  al)  refer  to  as  successful  gamification:  ‘the  use  of  design  elements  characteristic  for  

games   in   non-­‐game   contexts.’   (Deterding   et   al   2011:   13)   Also,   succesfull   gamification  

examples  like  codeacademy  are  mostly  to  be  found  in  the  top  layer  of  the  hierarchy  of  

needs;   the   self-­‐actualization.   They   make   you   better   at   something,   help   you   to  

specialize,   or   just   have   fun.   The   difference   between   the   bottom   layers   and   the   top  

layers  also  has  to  do  with  leisure;  the  bottom  ones  need  to  be  fulfilled  anyway,  while  

the   self-­‐actualization  needs  depend  on  how  much   time   you  have   left   after   you  have  

fulfilled  all  the  other  needs.  

How  does  this  all  relate  to  the  gamification  as  worked  out  by  Menzis?  In  their  

program,  Menzis  almost  exclusively  relies  on  basic  needs;  needs  that  are  to  be  found  in  

the  two  bottom  layers  of  the  pyramid,  those  that  refer  to  the  body  and  safety.  Health  is  

a  very  important  part  of  your  everyday  life;  if  you  are  ill,  you  are  unable  to  do  a  lot  of  

other  things.  All  you  want  is  to  get  better  -­‐  that  is  what  comes  before  anything  else.  Of  

course,   applying   for   ‘SamenGezond’   is   voluntary   (an   important   precondition   for  

games),  yet  it  dives  so  deep  into  your  basic  needs,  it  cannot  be  separated  from  it  again.  

Since  everyone   in   the  Netherlands   is  obliged   to  have  a  health   insurance,   it   is  not   so  

easy  to  get  away;  one  will  always  be  confronted  with  it.  

  What  stings,  too,  is  that  ‘being  healthy’  is  not  always  that  much  of  a  choice.  For  

example,   you   get  more   points  when   you   exercise  more   often;   yet,   there   are   a   lot   of  

people  that  do  not  have  the  physiological  ability  to  even  exercise  at  all.  This  makes  a  

preliminary   distinction   between   healthy   people   and   those   that   aren’t   healthy   –   but  

cannot   really   do   anything   about   it.   Some   see   a   healthy   body   as   something   you   are  

lucky  with;  for  Menzis,  it  has  become  more  or  less  measurable,  through  questionnaires  

                                                                                                               2  Epic  Win  (‘Level  up  your  life!’)  is  an  app  for  iPhone  which  gamifies  your  to-­‐do-­‐lists;  when  you  complete  tasks,  you  master  your  skills  and  level  up.  Includes  ‘epic  sounds’  and  a  track  of  everything  you’ve  ever  achieved  with  this  app.  Epic  Win,  through:  <http://www.rexbox.co.uk/epicwin/>  

  13  

and  rewarding  systems.  They  do  not  really  seem  to  make  a  distinction  between  ‘being  

ill’   and   ‘living  unhealthy’,  which  makes   the   ‘game’  unfair   since  being   ill   is  not   a   free  

choice,  whilst  living  unhealthy  often  is3.  

 

 

 

2.2 point systems

The   second   argument   I’d   like   to   make   has   to   do   with   the   reward   system   that  

‘SamenGezond’  uses.  For  everything  ‘good’  or   ‘healthy’  that  you  do,  you  will  receive  a  

fixed  amount  of  points,  up  to  a  maximum  of  5000  per  year.  They  do  not  explain  how  

they  have   set  up   this   system,   for  example  how   they  calculated   the  amount  of  points  

you  get   for   an   activity   or   behaviour.  They  do   explain   that   one  point  has   an   internal  

value  of  €0,01;  however,  in  the  web  shop,  a  point  usually  is  worth  more  money,  but  this  

is  variable  depending  on  the  product  or  discount4.  The  points  cannot  be  exchanged  for  

money;  only  partly  for  a  discount  on  your  insurance  premium.  The  rest  has  to  be  spent  

in  the  web  shop.  

  In  appendix  #2,  you  can  find  the   list  with  questions  Menzis  has  set  up  so  far.  

Currently,  these  are  the  only  options  to  gather  points.  More  options  will  be  added  in  

the  future.  When  looking  at  this,  some  questions  rise.  Who  checks  if  the  client  really  

fills  in  the  truth?  How  have  they  calculated  the  amount  of  points  for  a  specific  task  or  

behaviour?   Do   they   have   several   ‘categories’   of   health   related   topics   on   which   they  

base   their  point   system?  What   if   you  are   ill   –   are  you   then  being  excluded   from   the  

possibilities  of  earning  points?  

  First;  they  are  not  checking  if  you  really  are  exercising  as  often  as  you  filled  in  

on  your  list,  or  if  you  do  take  care  of  your  chronically  ill   friend  at  least  eight  hours  a  

week  for  more  than  three  months.  This  enables  you  to  lie  about  whether  you  are  living  

good  or  healthy.  Menzis  says  they  trust  their  clients  and  therefore  do  not  check  if  what  

their   clients   fill   in   is   actually   true.   I   agree   that   it  would   go   too   far   to  monitor   your  

clients  that  thoroughly,  yet  now  it  seems  like  everyone  just  could  do  anything  they’d  

like  to  do,  without  any  consequences.  Menzis  only  reward,  they  do  not  punish;  a  one-­‐

                                                                                                               3  This  is  something  that  can  be  discussed,  as  there  have  been  some  studies  showing  that  being  sensitive  for  addiction  might  be  hereditary.    4  Vragen  over  de  webshop  (Questions  about  the  webshop).  Menzis.  Last  viewed  on  14.9.2012.  <http://www.menzis.nl/web/WebshopSamenGezond.htm>  

  14  

sided  strategy  that  might  work  in  some  cases,  but  not  in  this  one.  As  Jeremy  Bentham  

described  in  his  book  The  Rationale  of  Reward,   ‘beside  the  effect  produced  by  its  own  

force,  it  also  sustains  the  value  of  the  reward’  (Bentham  1825:  19).    

  Second,  there  is  the  question  of  categories.  Some  of  the  actions  that  earn  you  

points   actually  do  not  have   anything   to  do  with   a   good  or  healthy   lifestyle;   the   first  

point  on  the  list,  for  example,  is  about  filling  in  your  declaration  forms  online,  instead  

of   sending   them   by   mail.   The   fourth   on   the   list   makes   you   earn   points   when   you  

subscribe   to   the   program;   you   get   extra   points   for   any   other   (family)   member   you  

subscribe  on  your  health  policy,  too  (for  example  your  children).  Someone  in  a  larger  

family   can   thus   earn  more  points   than   someone  who   lives   alone   and  doesn’t   have   a  

partner   or   children.  There   are  more  ways   in  which   this  distinction   counts;   someone  

that   doesn’t   have   the   (physical)   ability   to   go   to   the   gym  will  miss   out   on   75   points,  

because  of  pre-­‐existing  conditions.  This  favours  the  ‘naturally’  healthy  over  those  who  

cannot   do   anything   about   their   illness   or   disabilities.   Also,   when  Menzis   says   they  

started   this   program   because   they   want   people   to   live   good   and   healthy,   it   seems  

rather  strange  to  give  them  points  for  adding  members  or  declaring  their  forms  online  

–   since   this   does   not   relate   to   a   healthy   lifestyle   at   all.   It   is   only   useful   for   getting  

Menzis  more  customers;  but  this  is  (of  course)  not  what  they  give  up  as  a  reason.  

  But  what  I  find  fundamentally  wrong  with  rewarding  points  for  those  types  of  

activities   (varying   from   declarations   to   taking   care   of   your   loved   ones   and   eating  

apples  instead  of  candy  bars)  is  that  the  virtual,  in-­‐game  points  are  related  to  real-­‐life  

consequences.  This  is  something  that  other  theorists  have  been  thoroughly  discussing,  

too,  agreeing  that  this  usually  takes  out  the  fun;  it  gets  too  serious.  (Deterding  2011a)  

This  is  mostly  discussed  related  to  salary  bonuses,  but  I  have  not  yet  seen  any  author  

relate  it  to  types  of  gamification  in  the  field  of  health  or  other  ‘basic  needs’.  Caring  for  

your  loved  ones  will  let  you  be  rewarded  with  points  that  can  give  you  a  discount  on  a  

cookbook;   that   just   doesn’t   seem   right.  Caring   for   loved  ones   should  be   an   intrinsic  

motivation,  not  something  you  do  because  you  will  get  rewards  for  it.  An  example  of  

the   gamification  of  health   that  does   it   right  when   it   comes   to   this   last   point   is   Jane  

McGonigals   SuperBetter   (McGonigal   2011:   135-­‐142);   because   this   doesn’t   impose  

consequences,  you  make  them  yourself.  You  set  your  own  rules  and  standards,  which  

makes  your  motivations  and  rewards  both  intrinsic.    

 

  15  

conclusion

 

When  first  reading  the  different  points  of  view  that  are  represented  in  the  debate  on  

gamification,  it  felt  like  there  was  something  missing.  Most  points  of  view  come  from  a  

very  game-­‐design  perspective,   trying   to  define   first  what  games  are  exactly  and   than  

how  this  can  be  transferred  as  good  as  possible  to  something  that  actually  isn’t  a  game.  

Of  course,  the  ‘SpaarGezond’  program  by  Menzis  is  not  really  a  game.  Yet,  it  does  have  

some   particular   game   elements   (earning   points,   the   possibilities   to   face   challenges),  

which  makes  me  call  it  gamified.  While  Deterding  would  describe  it  as  an  unsuccessful  

example  of  gamification  because  it  does  not  meet  the  requirements  he  sets  out  in  his  

Google   Tech   Talk   (Deterding   2011a),   I   argue   this   gamification   is   unsuccessful   and,  

moreover,  not  desirable  because  it  refers  to  a  very  basic   level  of  human  needs,  which  

should  not  be  used  for  applying  gamification.  It  is  seen  that  many  successful  types  of  

gamification   are   to  be   found   in   the   top   layer   of   the  hierarchy  of   needs;   that   of   self-­‐

actualization,  where  one  can  develop  the  self,  specializing  and  becoming  an  expert  in  

what  one  really  desires.  ‘SamenGezond’  operates  on  a  basic  level,  and  moreover  hasn’t  

really  thought  through  their  system;  they  do  not  check  if  you  fill  in  your  lists  truthfully  

and  moreover  they  favour  the  average,  relatively  young  and  healthy  people,  favourably  

having   children   and   not   having   any   chronic   or   hereditary   illnesses,   exercising   quite  

often  and  eating  healthy  food.  On  top  of   it,   the  amount  of  points  you  get  seem  a  bit  

random;  you  get  the  same  amount  points  for  sending  in  your  declarations  online  as  for  

taking   care   of   your   loved   ones   intensively   (‘mantelzorger’).   And   as   such,   caring   for  

your   loved  ones   or   declaring   online,   can  be  used   for   discounts   on   your   premium  or  

products   in   the  web  shop.  This  connection   is  not  only  undesirable  when   it  comes  to  

ethical  terms,  but  even  when  relating  to  Deterding’s  talk  on  gamification;  one  should  

never  relate  in-­‐game  achievements  to  real-­‐life  consequences  (Deterding  2011a).  

 

I   hope   that   my   approach   towards   gamification   might   give   some   new   insights.  

Gamification  cannot  just  be  applied  to  everything  that  isn’t  a  game;  it  should  not  only  

been   done   in   a   way   that   does   justice   to   games,   but   foremost   keep   in  mind   ethical  

questions  that  might  come  to  rise.  

 

 

  16  

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Plourde,  Robert.  2012.  ‘The  UnitedHealth  Group  and  Gaming’.  Games  for  Health       Journal,  vol.  1,  issue  1:  p.  18-­‐20.  

Shteyngart,  Gary.  2010.  A  Super  Sad  True  Love  Story.  New  York,  Random  House.  

Zichermann,   Gabe,   Joselin   Linder.   2010.   Game-­‐Based   Marketing.   Inspire   Customer       Loyalty  Through  Rewards,  Challenges,  and  Contests.  US,  John  Wiley  &  Sons.  

Zichermann,   Gabe.   2010.   ‘The   Tech   Industry’s   Tea   Party.’  Huffington   Post,   7.12.2010.       Last   viewed   on   12.9.2012.   <http://www.huffingtonpost.com/gabe-­‐       zichermann/the-­‐tech-­‐industrys-­‐tea-­‐pa_b_792833.html>  

  17  

appendix #1: news article

 

17  september  2012,  08:58  

Gezonde  leefstijl?  Zorgverzekeraar  Menzis  beloont  dat  met  spaarpunten  

 Gezonder  leven  door  te  sporten  of  te  stoppen  met  roken  wordt  beloond  met  spaarpunten.  Reuters  /  Toby  Melville  

 

door  Marije  Willems    

BINNENLAND  Zorgverzekeraar  Menzis  gaat  mensen  die  gezonder  gaan  leven  door  te  

sporten  of  te  stoppen  met  roken  belonen  met  spaarpunten.  Die  kunnen  worden  

ingeruild  voor  korting  op  onder  meer  wellnessarrangementen,  een  rollator,  

fysiobehandeling  of  sportkleding,  zegt  bestuursvoorzitter  van  Menzis  Roger  van  Boxtel  

vandaag  in  het  AD.  

 

Klanten  kunnen  ook  punten  sparen  door  bloed  te  doneren,  zich  op  te  geven  voor  

orgaandonatie  of  zich  in  te  zetten  als  mantelzorger.  Voor  het  programma  hebben  zich  

in  een  week  tijd  twaalfduizend  van  de  twintigduizend  aangeschreven  klanten  

aangemeld.  Menzis  heeft  in  totaal  1,2  miljoen  verzekerden.  

 

  18  

Mensen  met  een  gezonde  leefstijl  zijn  minder  vaak  ziek  en  gaan  dus  minder  vaak  naar  

de  dokter,  redeneert  Van  Boxtel.  Op  die  manier  worden  volgens  hem  zorgkosten  

bespaard.  

 

MAXIMALE  KORTING  VAN  35  EURO  PER  JAAR  

Verzekerden  kunnen  in  drie  jaar  tijd  maximaal  ongeveer  250  euro  aan  kortingen  

sparen.  Wie  zijn  punten  inzet  om  zijn  eigen  risico  mee  te  betalen,  kan  zo  maximaal  

een  korting  van  35  euro  per  jaar  krijgen.  

 

De  discussie  over  het  bestraffen  van  ongezond  gedrag  loopt  al  langer.  Verzekerden  

hoeven  volgens  Van  Boxtel  niet  bang  te  zijn  dat  ze  meer  moeten  betalen  als  ze  

aangeven  dat  ze  roken.  Volgens  hem  werkt  het  geven  van  korting  voor  goed  gedrag  

beter  dan  het  bestraffen  van  slecht  gedrag.  

 

‘GEEN  MENZISPOLITIE  DIE  CONTROLEERT  OF  IEMAND  GAAT  SPORTEN’  

“We  gaan  ook  geen  Menzispolitie  inzetten  om  te  controleren  of  iemand  daadwerkelijk  

is  gaan  sporten.”  

Wel  houdt  hij  de  mogelijkheid  open  dat  er  steekproeven  worden  gehouden.  

  19  

appendix #2: current point system (SamenGezond, Menzis)

 

This  is  the  current  list  of  possibilities  to  earn  points.  I  have  received  it  from  Menzis  in  

an  e-­‐mailcorrespondence;  it  is  not  to  be  found  online  (yet).