Behavioral Economics Policy Impact and Future Directions (2023) / Chapter Skim
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5 Health
5 Health
Pages 95-116
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From page 95... ...
Health researchers have been designing and testing interventions grounded in core behavioral economics principles to encourage positive outcomes for individuals and patients and support provider decision making for more than 20 years. A wide range of behavioral ideas have been tested in varied settings.
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A 2019 meta-analysis reviewed the long-term effectiveness of financial incentives on smoking cessation, identifying 33 mixedpopulation, randomized controlled trials (Notley et al., 2019)
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. This work overall is a good illustration of how behaviorally informed incentives are distinct from traditional economic incentives.
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A review of 15 randomized and six nonrandomized studies showed that behaviorally informed financial incentive interventions (in this case, ones that have been framed to address behavioral reasons people fail to adhere) significantly improved medication adherence.
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Studies have suggested that sustained behavior change is achievable through a variety of behavioral mechanisms, including classic habit formation, learning by doing, information acquisition, addressing status quo bias, discovery of new 1That is, no approach has achieved effects in large populations, in contrast with laboratory settings or other controlled experimental circumstances.
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. However, the most studied approach has been the use of behaviorally informed financial incentives.
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PROMOTING PREVENTIVE CARE Behavioral economics findings have been applied in interventions to encourage people to engage in a wide variety of other preventive activities to promote health. We identified three examples with a substantial evidence base: colorectal cancer screening, HIV prevention and treatment, and vaccination.
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rather than sending the kits only to those who explicitly requested them. A separate systematic review and meta-analysis of studies found that financial incentives added onto a mail outreach program may also have modest benefit (Facciorusso et al., 2021)
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. A review of behaviorally informed financial incentives to promote HIV testing found that incentives were effective, whether the incentives included a guaranteed monetary reward; a lottery; or nonmonetary rewards, such as a food voucher (Lee et al., 2014)
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found that the most promising behavioral evidence for increasing rates of vaccination (where it is not required) points to three strategies: making information about vaccines more salient (e.g., Milkman et al., 2011; Chen et al., 2020; Szilagyi et al., 2020)
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From page 105... ...
More generally, clinicians clearly respond to traditional economic incentives: they provide more services when they are paid per service than when they are paid through such arrangements as salary or full-risk capitation, which raises concerns about potential conflicts with their patients' best interests (Larkin & Loewenstein, 2017)
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From page 106... ...
. These effects were much larger than those observed in some other efforts to use social norms and social comparisons to motivate behavior change.
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From page 107... ...
That variability may relate to such factors as the timing of interventions, the comparison groups used, the salience of the information provided, the source of information, the fidelity of implementation, or the degree to which comparative information provided new information. Finally, a number of studies have examined the use of financial incentives, such as bonuses for improved quality, as an enhancement to the existing fee-for-service payment system.
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From page 108... ...
• Default or opt-out interventions were the most successful among in terventions tried for increasing rates of colorectal cancer screening. • Behaviorally informed financial incentives, promotion of testing and treatment services, and provision of information about HIV risk and treatment effectiveness were all promising interventions for increasing HIV prevention and adherence to treatment.
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From page 109... ...
While this identification typically requires large samples for adequately powered subgroup analyses, this approach could make possible the tailoring of interventions to different populations, increasing the amount of benefit for the resources expended. Designing for Scaling and Planned Replication Recent popular books, such as The Voltage Effect: How to Make Good Ideas Great and Great Ideas Scale by John List, have highlighted that promising ideas often do not scale because the initial demonstration of efficacy may represent a best-case scenario.
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. Adaptive goal setting and financial incentives: A 2 × 2 factorial randomized controlled trial to increase adults' physical activity.
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. Loss‐framed financial incentives and personalized goal‐setting to increase physical activity among ischemic heart disease patients using wearable devices: The ACTIVE REWARD randomized trial.
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. Addition of financial incentives to mailed outreach for promoting colorectal cancer screening: A systematic review and meta-analysis.
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. Effectiveness of financial incentives in achieving UNAID fast-track 90-90-90 and 95-95-95 target of HIV care continuum: A systematic review and meta-analysis of randomized controlled trials.
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. Framing financial incentives to increase physical activity among overweight and obese adults: A randomized, controlled trial.
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. Effectiveness of behavioural economics-based interventions to improve colorectal cancer screening participation: A rapid systematic review of randomised controlled trials.
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From page 116... ...
. The new landscape of medication adherence improvement: Where population health science meets precision medicine.
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