{"id":737,"date":"2015-09-03T08:17:24","date_gmt":"2015-09-03T08:17:24","guid":{"rendered":"http:\/\/www.behaviouraleconomic.co.uk\/?p=737"},"modified":"2022-02-17T07:10:02","modified_gmt":"2022-02-17T07:10:02","slug":"behavioural-economics-and-healthcare-a-match-made-in-heaven","status":"publish","type":"post","link":"https:\/\/www.behaviouraleconomic.co.uk\/behavioural-economics-and-healthcare-a-match-made-in-heaven\/","title":{"rendered":"Behavioral Economics and Healthcare: A Match Made in Heaven"},"content":{"rendered":"

By Benjamin Voyer<\/em><\/p>\n

 <\/p>\n

Out of all the areas of public life that can benefit from the applications of behavioural economics (BE) principles, healthcare is probably the one where it can make the biggest societal contribution. There are two main reasons why the healthcare industry should welcome (more!) BE\u00a0insights. The first reason is that many of the traditional ways in which marketing and economics principles have been applied to health are starting to show their limits (e.g. \u2018rational\u2019 prevention campaigns or \u2018shock-advertising\u2019 commercials used to reduce road accidents or smoking). The second is that BE\u00a0allows for more efficient policies and reduced costs, which is\u00a0much welcomed in a healthcare industry facing financial and budgetary challenges. In this post, I highlight ways in which some of the key principles of BE have been \u2013 or could be \u2013 applied in a healthcare context.<\/p>\n

Johnson and Goldstein\u2019s (2003) seminal study on organ donations is probably the most \u2018classic\u2019 example of BE applied to public health. They showed how simple interventions, such as registering individuals by default on the organ donation register (people have to opt out if they do not wish to be a donor), could significantly increase organ donations. Governments have also\u00a0encouraged (and in some cases required) companies to sign up employees to pension schemes by default in order to increase pension savings. The same principles can be applied to other areas of public health if\u00a0taking out medical cover or insurance is\u00a0made a\u00a0default.<\/p>\n

Another principle of BE\u00a0which has interesting and relevant applications in healthcare is that of temporal discounting \u2013 the fact that individuals value more what is available immediately rather than what might come in a distant future. This principle has consequences for the management of chronic diseases, for instance, when patients struggle to appreciate\u00a0the benefits of small behaviours with incremental effects that can avoid long-term costly consequences. Focusing on smaller, short-term goals \u2013 e.g. loosing 2 lbs per month, in the case of weight-loss \u2013 can be more beneficial than putting forward a long-term ambitious achievement (e.g. 24 lbs of weight loss in one year).<\/p>\n

Patient-related decisions often involve a certain amount of risk, an understanding of which can benefit from BE. Given the difficulties in assessing risks in healthcare, and patients\u2019 aversion to risks, doctors can help patients make more informed decisions by offering clear comparison \u2013 e.g. in the form of a summary table – between risks and benefits. For instance, choices between surgery and drug-based alternatives can be made easier by listing advantages and disadvantages of each alternative (i.e. immediate, short and medium, long term benefits, and associated side-effects). Choices could also be presented in a way that allows patients to understand what their implicit preferences are. For instance, this may involve\u00a0a survey of\u00a0patients that uses\u00a0forced-choice options, asking them to choose between what they value most (e.g. being fully mobile vs. pain-free, when considering hip-replacement surgery).<\/p>\n

Finally, behavioural principles related to the social aspects of decision-making can be successfully applied to healthcare.<\/p>\n

Giving patients some feedback on how they are doing in relation to their treatment and progress, possibly compared\u00a0to another group or\u00a0age cohort, can motivate people to improve their behaviours and stick to treatments, or effectively\u00a0trigger a desire to change behaviour and improve to do better than average. This has been used, for instance, to convince patients to quit smoking, by giving them feedback on the \u2018age\u2019 of their lungs, compared with a cohort of non-smoking individuals (Parkes, Greenhalgh, Griffin, & Dent, 2008).<\/p>\n

These same ideas\u00a0can also be applied by hospital\u00a0management to improve staff behaviour\u00a0within hospitals and clinics. Hospital managers can improve healthcare services by monitoring and giving feedback about services\u2019 relative\u00a0performance. For instance, Armellino and colleagues (2011) showed that using real-time video monitoring and feedback of hand sanitizing in a critical-care unit could increase usage by more than 800%. The more cohesive a team is, the more they will be motivated by changing their behaviour to perform better than other teams or services. Messages that incorporate social norms can also help to reduce the number of missed appointments among patients. Martin, Bassi, Dunbar-Rees (2012) found that, when patients were exposed to norms expressed as\u00a0the number of patients who turned up for their appointments \u2013 instead of past reference to missed appointments \u2013 this resulted in a 32% reduction of non-compliance. Making feedback as precise and targeted as possible can maximize the effects (e.g. \u201880% of patients arrive on time. Be one of them!\u2019 will be more efficient than a message \u2018most patients arrive on time\u2019).<\/p>\n

Another\u00a0message\u00a0aimed at patients in\u00a0hospital settings encourages them to respect staff (e.g. \u2018treat our doctors and nurses the way you would like to be treated\u2019). This follows\u00a0the principle of reciprocity,<\/strong>\u00a0inciting people\u00a0to reciprocate an actual or hypothetical behaviour, which can result in behavioural change. Organ donations, for example, can be increased when the message \u2018if you needed an organ, would you take one?\u2019 is used in a communication campaign. For organ recipients, some scholars have even suggested that patients\u00a0who are themselves registered on the donors\u2019 list should have\u00a0preferential status. Individuals would thus be encouraged to register on the donor\u2019s list as a matter of reciprocity — they would\u00a0be given preference over someone not registered if they needed an organ donation at a later time.<\/p>\n

Overall, BE\u00a0principles can be used and benefit healthcare in many ways. A promising area for research and applications of BE\u00a0in healthcare is through\u00a0gamification<\/em>\u00a0<\/em>of e-health. Games can be designed to incorporate many BE\u00a0principles, such as framing decisions, giving feedback on norms and behaviours, setting small and realistic short-term objectives, etc. E-health ensures accurate, personal, and real-time feedback, which can reinforce the efficiency of the messages. Studies have shown that health-monitoring devices (e.g. Fitbit or Apple Watch) can provide useful real-time feedback on health metrics. The real-time aspect of the data can be combined with real-time feedback as parts of games or challenges (e.g. take at least 10,000 steps per day; converting exercise data into points or \u2018lives\u2019 for games), to increase individual motivation and agency, thereby triggering behavioural change.<\/p>\n

While advances in behavioural science provide a promising avenue to achieve behaviour change, it is becoming increasingly clear that the application of BE\u00a0principles does not always guarantee results, and other forms of incentives can work equally well if not better (e.g. taxation or financial rewards). Healthcare has long relied on the use of randomized controlled trials (RCTs) to test the efficacy of interventions, and it can continue to lead the way forward in\u00a0this area of\u00a0applied\u00a0behavioural science. RCTs\u00a0can be used to test and validate programs designed to achieve positive behaviour change. However, some have questioned the ethicality of applying\u00a0BE\u00a0principles in the form of ‘nudging’, and RCTs may be controversial if they are applied to\u00a0serious healthcare issues, especially\u00a0those involving life or death matters. In addition, there is an increasing awareness that the\u00a0effects achieved by behavioural interventions\u00a0may\u00a0wear off over time. For this reason, the design of RCTs may have to become more ambitious by also\u00a0measuring effects in the medium or long term.<\/p>\n

 <\/p>\n

 <\/p>\n

For more on this topic, please read:<\/p>\n

Voyer, B.G. (2015) \u2018Nudging\u2019 behaviours in healthcare management: Insights from Behavioural Economics, British Journal of Healthcare Management, <\/strong>Volume 21 (3), Pages: 130-135, special issue \u2018innovation in healthcare<\/em>\u2019<\/p>\n

Sola, D., & Couturier, J., Voyer, B.G. (2015), Unlocking patient activation: Coupling e-health solutions coupled with gamification, British Journal of Healthcare Management<\/strong>, 21 (5), pp 223-228<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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He received a PhD in Social Psychology from the London School of Economics (LSE), and a doctorate of science in management (DSc \/ Habilitation \u00e0 Diriger des Recherches) from the Sorbonne University in Paris. He also studied marketing at HEC Paris and the London Business School. He is a chartered psychologist in the UK (CPsychol), a chartered scientist (CSci), a chartered marketer (MCIM), and Associate Fellow of the British Psychological Society (AFBPsS). Prof. Dr Voyer is an interdisciplinary researcher, investigating how self-perception can affect consumption and behaviours in organisations. He has authored or co-authored more than 100 scientific contributions to the field of applied psychology (journal articles, conference presentations, case studies...). 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He worked for several years as a marketing practitioner in different industries, including FMCGs, banks, and public institutions and remains a freelance consultant in the area of marketing and organisational psychology.","sameAs":["http:\/\/www.benvoyer.com"]}]}},"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/www.behaviouraleconomic.co.uk\/wp-content\/uploads\/2015\/09\/Health.png","jetpack_shortlink":"https:\/\/wp.me\/pc89nr-bT","_links":{"self":[{"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/posts\/737"}],"collection":[{"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/comments?post=737"}],"version-history":[{"count":0,"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/posts\/737\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/media\/786"}],"wp:attachment":[{"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/media?parent=737"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/categories?post=737"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/tags?post=737"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.behaviouraleconomic.co.uk\/wp-json\/wp\/v2\/coauthors?post=737"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}