A behavioral blueprint for improving health care policy
David Hagmann
Sign up for access to the world's latest research
checkGet notified about relevant papers
checkSave papers to use in your research
checkJoin the discussion with peers
checkTrack your impact
Abstract
Behavioral policy to improve health and health care often relies on interventions, such as nudges, which target individual behaviors. But the most promising applications of behavioral insights in this area involve more far-reaching and systemic interventions. In this article, we propose a series of policies inspired by behavioral research that we believe offer the greatest potential for success. These include interventions to improve health-related behaviors, health insurance access, decisions about insurance plans, end-of-life care, and rates of medical (for example, organ and blood) donation. We conclude with a discussion of new technologies, such as electronic medical records and web- or mobile-based decision apps, which can enhance doctor and patient adherence to best medical practices. These technologies, however, also pose new challenges that can undermine the effectiveness of medical care delivery.
Related papers
Seeking Better Health Care Outcomes: The Ethics of Using The Nudge
Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for the utilization of each principle.
Nudge to Health: Harnessing Decision Research to Promote Health Behavior
Social and Personality Psychology Compass, 2013
We review selected literature that examines how biases in decision making can be utilized to encourage individual health behavior, such as vaccination, and promote policy decisions, such as resource allocation. These studies use simple interventions to nudge people towards more optimal health decisions without restricting decision-makers' freedom of choice. Examples include framing effects, defaults, implementation intentions, position effects, social norm, incentives, and emotions. We suggest that nudges are an effective way to promote healthy behavior.
Li, M. & Chapman, G.B. (2013) Nudge to Health: Harnessing decision research to promote health behavior. Social and Personality Psychology Compass
We review selected literature that examines how biases in decision making can be utilized to encourage individual health behavior, such as vaccination, and promote policy decisions, such as resource allocation. These studies use simple interventions to nudge people towards more optimal health decisions without restricting decision-makers' freedom of choice. Examples include framing effects, defaults, implementation intentions, position effects, social norm, incentives, and emotions. We suggest that nudges are an effective way to promote healthy behavior.
The value of healthcare data: to nudge, or not
Policy Studies, 2020
The processes of datafication, digitization and automation of healthcare and medicine are making new types and data available for analysis, and at greater volume. While the newly available data is often hailed as a solution to various problems in healthcare, there is only little discussion about who the use of such data empowers and who bears the costs. The use of healthcare data for “nudging”–e.g. to get patients to adopt healthier lifestyles–is a case in point: While such interventions are presumed to be cheap and effective, I argue that their value is a priori unclear. Both because of its assumed value-freeness, and because of its focus on individual behaviour, nudging draws attention away from the societal, political and economic factors that shape human practice. I conclude with a call upon policy makers to facilitate the use of healthcare data to build better institutions and to address social determinants of health before they seek to “fix” individual behaviour through nudging.
Health Care Reform and Efforts to Encourage Healthy Choices by Individuals
2014
I am grateful for the excellent editing by Anna Tison and the other editors of the North Carolina Law Review who contributed to this Article. 1. Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010) (codified as amended in scattered sections of 25, 26, 29 and 42 U.S.C.). 2. By prohibiting premium surcharges for sicker individuals and providing greater funding for lower-income families, the ACA will ensure that millions more Americans can afford the medical care that they need. Funding for lower-income families takes two primary forms. First, millions more of the poor will be eligible for Medicaid under the ACA's Medicaid expansion provisions, which provide for coverage to all persons whose family income does not exceed 138% of the federal poverty level.
Behavioral Approach to Health Policies: Nudge Prejudices
8th International Symposium on Social Sciences, EJSER, 2021
While trying to compensate for the devastating effects of the Covid-19 epidemic in the world, the supply chain from energy to agriculture and food, the supply chain extending from the health sector to the economy is also protected. Although the epidemic process has created many psychological and sociological difficulties, it has also created awareness in the health sector about individual interaction and behavior patterns or individual-society relationship. These behavioral approaches, which form the main lines of human and social sciences, are also widely used in multidisciplinary fields such as public policy and economics. As a result of the studies, it has been determined that people exhibit attitudes far from rationality and fall into cognitive misconceptions. However, these behaviors can be brought under control by consciously triggering instructions to individuals within certain limits. This approach, which is considered as "nudging" in the economic literature, can keep people away from acting irrationally and is frequently used in public policy practices. For this purpose, in this study, decision-making behaviors against some problems observed in the health sector were examined using the survey method in the light of "nudge". It is expected that the results obtained will contribute to the policies and decision mechanisms in the relevant sector.
National Institutes of Health Funding for Behavioral Interventions to Prevent Chronic Diseases
American journal of preventive medicine, 2015
Chronic non-communicable diseases (NCDs) cause the majority of premature deaths, disability, and healthcare expenditures in the U.S. Six largely modifiable risk behaviors and factors (tobacco use, poor nutrition, physical inactivity, alcohol abuse, drug abuse, and poor mental health) account for more than 50% of premature mortality and considerably more morbidity and disability. The IOM proposed that population burden of disease and preventability should be major determinants of the amount of research funding provided by the U.S. NIH. Data on NIH prevention funding between fiscal years 2010 and 2012 for human behavioral interventions that target the modifiable risk factors of NCDs were analyzed during 2013-2014. The NIH prevention portfolio comprises approximately 37% human behavioral studies and 63% basic biomedical, genetic, and animal studies. Approximately 65% of studies were secondary prevention versus 23% for primary prevention, and 71% of studies intervened at the individual ...
Behavioral Economics and Health: Nudging for our own good
2018
Each of us is made up of the decisions that we make. The rich tapestry of our lives is constructed from the hundreds of thousands of decisions that have led us to this very moment. If each of us were endowed with perfect rationality, our optimal decision-making qualities might lead us down similar paths. But here we are, instead each of us on unique and sometime bumpy rides accentuated by our perfectly irrational choices. The goal of my research is to make sense of our faulty decision making in areas related to personal health by applying insights from the field of behavioral economics. I am not the only one searching for answers. It's an exciting time to be a behavioral economist in light of the relatively recent birth of the subfield, as a splinter off of the traditional economics cutting block. It is a moment of prolific research in a thriving field of economists seeking to understand how exactly we err in the decision-making process, and what precisely can be done to help us...
Related papers
EMPLOYING BEHAVIORAL AND SOCIAL SCIENCE TO MEET CHALLENGES IN HEALTH CARE QUALITY IMPROVEMENT
The key issue for this think tank session stems from a number of related challenges in U.S. health care. Healthcare expenditures in the U.S. are huge, and continue to increase at rates well above inflation.(cite) 2) The quality of healthcare in the United Statesthat is, the extent to which the system does the right thing for the right patient at the right time in the right way 1 2 --leaves much to be desired and the pace of improvement has been slow. 3 Racial/ethnic and socioeconomic disparities in healthcare quality persist and in some cases are growing worse. Advances in information technology have finally permitted healthcare policymakers to envision a day when the use of information technology in healthcare delivery will facilitate improvements in healthcare quality and reductions in disparities. 4 Innovations in clinical settings, such as electronic medical records (EMRs), computerized order entry (COE) with computerized decision support (CDS) and electronic prescribing (eRx), have on occasion showed promising results for preventing medical (including medication) errors. Interoperable health information technology (HIT) used in regional applications called Health Care Innovation Exchanges (HCIE) are promising venue to increase care transitions and coordination across multiple providers and settings in the highly fragmented U.S. health care information. 4 However, adoption of HIT has been slow and many health care providers are skeptical that HIT will improve things for them or their patients.
Healthy Choices: Regulatory Design and Processing Modes of Health Decisions
SSRN Electronic Journal, 2000
This article demonstrates experimentally that individuals making decisions about their health management are affected by the decision making environment and that law and policy can serve important roles in improving the decision environment. With the support of a generous grant from the Robert Wood Johnson Foundation, we conducted two series of experiments. First a lab experiment with approximately 700 respondents and next a web-based experiment with over 3000 respondents, including 300 medical doctors. In each of the experiments, in addition to manipulating the decision making environment and choice sets, we manipulated the state of the decision maker. In the first series of experiments we used the psychological mechanism of cognitive depletion and in the second series we tested the effects of cognitive overload. Most broadly, unlike past measures of risk aversion, our studies demonstrate that preferences for risk are not fixed in an individual but rather are highly sensitive to the role, context, and state of the decision maker in patterned ways. The project provides new evidence that cognitive processes affect decision making and judgment of risk, often leading to medically suboptimal choices. The lab studies suggest that often people process risk sub-optimally, e.g. favoring potentially harmful omissions over less harmful acts and being influenced by the order of warnings or choices, rather than their substantive value.
nudging CHronic disease mANaGemEnt for empowering citizens: the CHANGE project
2020
Objective: Chronic diseases (CDs) are major causes of deaths, disabilities and healthcare expenditure worldwide. Interventions aimed to prevent or mitigate the impact of CDs need to be added to the traditional healthcare methods. The main purpose of the CHANGE project is the development and validation of a new Nudge theory-based Information and Communications Technology (ICT) coach system for monitoring and empowering patients with CDs. Methods: A randomized controlled clinical trial involving 200 patients with CDs will be implemented. Online assessment of demographic, psychological, neuropsychological, and behavioral outcomes will be carried out through the users' device (smartwatches). A machine learning algorithm-based profile will elaborate specific nudge-based notifications, and suggestions will be returned to participants via the CHANGE App. Expected results: real-time monitoring and tutoring will pre-vent/decelerate the worsening of clinical conditions and will improve the physical and psycho-social health of patients with CDs. Moreover, the provision of tailored care actions will contribute to a more sustainable healthcare system.
Nudging best practice: the HITECH act and behavioral medicine
Translational Behavioral Medicine, 2010
User-Centered Development of a Behavioral Economics Inspired Electronic Health Record Clinical Decision Support Module
Studies in health technology and informatics, 2019
Changing physician behaviors is difficult. Electronic health record (EHR) clinical decision support (CDS) offers an opportunity to promote guideline adherence. Behavioral economics (BE) has shown success as an approach to supporting evidence-based decision-making with little additional cognitive burden. We applied a user-centered approach to incorporate BE “nudges” into a CDS module in two “vanguard” sites utilizing: (1) semi-structured interviews with key informants (n=8); (2) a design thinking workshop; and (3) semi-structured group interviews with clinicians. In the 133 day development phase at two clinics, the navigator section fired 299 times for 27 unique clinicians. The inbasket refill alert fired 124 times for 22 clinicians. Fifteen prescriptions for metformin were written by 11 clinicians. Our user-centered approach yielded a BE- driven CDS module with relatively high utilization by clinicians. Next steps include the addition of two modules and continued tracking of utiliza...
Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon
Health Affairs
Designing for implementation: user-centered development and pilot testing of a behavioral economic-inspired electronic health record clinical decision support module
Pilot and Feasibility Studies, 2019
Background: Current guidelines recommend less aggressive target hemoglobin A1c (HbA1c) levels based on older age and lower life expectancy for older adults with diabetes. The effectiveness of electronic health record (EHR) clinical decision support (CDS) in promoting guideline adherence is undermined by alert fatigue and poor workflow integration. Integrating behavioral economics (BE) and CDS tools is a novel approach to improving adherence to guidelines while minimizing clinician burden. Methods: We will apply a systematic, user-centered design approach to incorporate BE "nudges" into a CDS module and will perform user testing in two "vanguard" sites. To accomplish this, we will conduct (1) semistructured interviews with key informants (n = 8), (2) a 2-h, design-thinking workshop to derive and refine initial module ideas, and (3) semi-structured group interviews at each site with clinic leaders and clinicians to elicit feedback on three proposed nudge module components (navigator section, inbasket refill protocol, medication preference list). Detailed field notes will be summarized by module idea and usability theme for rapid iteration. Frequency of firing and user action taken will be assessed in the first month of implementation via EHR reporting to confirm that module components and related reporting are working as expected as well as assess utilization. To assess the utilization and feasibility of the new tools and generate estimates of clinician compliance with the Choosing Wisely guideline for diabetes management in older adults, a 6-month, single-arm pilot study of the BE-EHR module will be conducted in six outpatient primary care clinics. Discussion: We hypothesize that a low burden, user-centered approach to design will yield a BE-driven, CDS module with relatively high utilization by clinicians. The resulting module will establish a platform for exploring the ability of BE concepts embedded within the EHR to affect guideline adherence for other use cases.
“Comprehensive Healthcare for America”: Using the Insights of Behavioral Economics to Transform the U. S. Healthcare System
Journal of Law Medicine & Ethics, 2023
T he United States needs an efficient, effective, and politically feasible way to provide all Americans with access to affordable healthcare. We propose a new healthcare system named "Comprehensive Healthcare for America" (CHA). The 2021 report of the Commonwealth Fund on the performance of the US healthcare system compared to those of 10 other high-income countries is damning. Even with the Affordable Care Act (ACA), the US ranks last in access to care, equity, administrative efficiency, and healthcare outcomes. As a result, it ranks far below all the others in overall performance, despite vastly higher spending. The American public agrees: in the West Health-Gallup survey in June 21-30, 2022, 44% gave the health system a grade of D or F. What can be done? An obvious solution would be a single payer system, an expanded and improved "Medicare for All," long advocated by Physicians for a National Health Program. It would provide universal access and comprehensive benefits, would be equitable, and would reduce administrative barriers and costs. The Medicare for All bills of Bernie Sanders in the Senate and Pramila Jayapal in the House of Representatives would, after a 2-4 year transitional buy-in period, institute automatic enrollment for everyone (except for those insured by the Department of Veterans Affairs and the Indian Health Service). 3 This solution would be in line with the health systems of other high-income countries, which provide universal health insurance -generally considered a right -through either single payer systems or mixed systems with considerable governmental control.
Why Behavioral And Environmental Interventions Are Needed To Improve Health At Lower Cost
Health Affairs, 2011
We used a dynamic simulation model of the US health system to test three proposed strategies to reduce deaths and improve the cost-effectiveness of interventions: expanding health insurance coverage, delivering better preventive and chronic care, and protecting health by enabling healthier behavior and improving environmental conditions. We found that each alone could save lives and provide good economic value, but they are likely to be more effective in combination. Although coverage and care save lives quickly, they tend to increase costs. The impact of protection grows more gradually, but it is a critical ingredient over time for lowering both the number of deaths and reducing costs. Only protection slows the growth in the prevalence of disease and injury and thereby alleviates rather than exacerbates demand on limited primary care capacity. When added to a simulated scenario with coverage and care, protection could save 90 percent more lives and reduce costs by 30 percent in year 10; by year 25, that same investment in protection could save about 140 percent more lives and reduce costs by 62 percent.
Feasibility of implementing a behavioral economics mobile health platform for individuals with behavioral health conditions
Health and Technology
Coordinated Behavioral Care’s (CBC) Pathway Home™ (PH) program partnered with Wellth, Inc., a mobile health platform grounded in behavioral economics theory, to help individuals with behavioral health conditions build and reinforce health habits by providing daily reminders to take medication, requiring tasks (photos demonstrating remembrance), and providing financial incentives tied to behaviors. CBC made Wellth, Inc. available to individuals enrolling in its PH program for the purpose of demonstrating the feasibility of implementing a novel mobile technology grounded in behavioral economic theory to increase habits of health activities, such as taking medication, among adults with behavioral health conditions.
Loading Preview
Sorry, preview is currently unavailable. You can download the paper by clicking the button above.