Behavioral Economics and Health Care

Behavioral economics, which tries to understand how humans actually approach real world problems and use that understanding to either help individuals make better decisions or to nudge them in a perceived “right” direction.  There has been obvious interest in applying the techniques to health care.  Express Scripts, the large PBM, has conducted research along these lines.  The Robert Wood Johnson Foundation has set aside a pool of money for research in using behavioral economics in health care and has issued an interim report.  (RWJ Report)   Among some common findings in behavioral economics are that people tend to underweight the cumulative effect of small decisions, favor immediate gratification, take a default option or the one the requires the least effort and to respond to how decisions are framed.  So “experts” have worked on creating a choice architecture that moves people in what they believe is the right direction.

RWJ is focused on what it considers persistently difficult problems in health care–obesity, lack of exercise and overuse of doctors of low-value treatments.  RWJ is both funding studies and hosting conferences to help spread the knowledge gained.  Eight studies were funded in a first round and six more were added in a second round.  The first round studies look at very specific incentives or ways of presenting choices to consumers and the second focuses on limiting low-value procedures through affecting the behavior of patients and providers.    Overall, there is perception that the first round studies, many of which are complete, had mixed results and those that were successful had small effects.  A study that looked at how to encourage students to get flu shots found that only offering a financial incentive had any impact on flu shot rates.  Another study found that color-coded stickers on food that indicated the level of healthiness increased use of healthy foods and decreased unhealthy ones and coupling the stickers with financial incentives created even greater improvement.

These studies are valuable whether the intervention is successful or not because they add to the knowledge we have about health-related behaviors.  The primary issue we have with behavioral economics is when it is used in a paternalistic fashion by those in positions of power to often unconsciously manipulate behavior.  That is inconsistent with what should be the health care profession’s dedication to human dignity and independence.