Behavioral Economics / Behavior Change

The application of principles of economics and psychology to examine how individuals make choices in complex contexts--such as personal finances and health--and to improve these decisions and behaviors.

Generic Medication Prescription Rates After Health System–Wide Redesign of Default Options Within the Electronic Health Record

May. 19, 2016

Mitesh Patel, Susan Day, Scott Halpern, William Hanson, Joseph Martinez, Steven Honeywell Jr, Kevin Volpp

In JAMA Internal Medicine, Mitesh Patel and colleagues, including Scott Halpern and Kevin Volpp, evaluate how changing electronic health record (EHR) defaults affects physician prescribing of generic drugs. For the study, the researchers utilized a systemic change to the University of Pennsylvania Health System’s EHR defaults. As part of this change, an opt-out checkbox labeled “dispense as written” was added to the prescription screen, and if left unchecked the generic-equivalent medication was prescribed. The authors find that generic prescribing rates increased significantly...

Effect of a Financial Incentive for Colorectal Cancer Screening Adherence on the Appropriateness of Colonoscopy Orders

May. 18, 2016

Thomas B. Morland, Marie Synnestvedt, Steven Honeywell Jr, Feifel Yang, Katrina Armstrong, Carmen Guerra

Abstract: Performance incentives for preventive care may encourage inappropriate testing, such as cancer screening for patients with short life expectancies. Defining screening colonoscopies for patients with a >50% 4-year mortality risk as inappropriate, the authors performed a pre-post analysis assessing the effect of introducing a cancer screening incentive on the proportion of screening colonoscopy orders that were inappropriate. Among 2078 orders placed by 23 attending physicians in 4 academic general internal medicine practices, only 0.6% (n = 6/1057) of screening colonoscopy...

Impact of State Ignition Interlock Laws on Alcohol-Involved Crash Deaths in the United States

Apr. 13, 2016

Elinore Kaufman, Douglas Wiebe

In the American Journal of Public Health, Elinore Kaufman and Douglas Wiebe investigate the impact of universal ignition interlock requirements on car crash deaths involving alcohol. Ignition interlocks use breath-analysis technology to prevent intoxicated drivers from taking the wheel. The authors analyzed data from the National Highway Traffic Safety Administration for 1999 to 2013. They compared alcohol-related car crash deaths in the 18 states with universal interlock requirements to the 32 states without them. They find that in states that require universal ignition...

Individual Versus Team-Based Financial Incentives to Increase Physical Activity: A Randomized, Controlled Trial

Mar. 22, 2016

Mitesh Patel, David Asch, Roy Rosin, Dylan Small, Scarlett Bellamy, Kimberly Eberbach, Karen Walters, Nancy Haff, Samantha Lee, Lisa Wesby, Karen Hoffer, David Shuttleworth, Devon Taylor, Victoria Hilbert, Jingsan Zhu, Lin Yang, Xingmei Wang, Kevin Volpp

In the Journal of General Internal Medicine, Mitesh Patel and colleagues, including David Asch, Roy Rosin, Dylan Small and Kevin Volpp, compare the effectiveness of individual versus team-based financed incentives for increasing physical activity. Patel and colleagues conducted a randomized, controlled trial testing three interventions with more than 300 adults organized into 76 four-member teams. All participants received daily feedback on progress towards achieving a daily 7000- step goal during the intervention and follow-up periods, each 13 weeks. The control arm received no...

Habit formation in children: Evidence from incentives for healthy eating

Mar. 14, 2016

George Loewenstein, Joseph Price, Kevin Volpp

In the Journal of Health Economics, George Loewenstein and colleagues, including Kevin Volpp, examine the role of incentives in promoting healthy eating behaviors in children. The investigators conducted a field experiment at 40 elementary schools involving 8,000 children and 400,000 child-day observations, which tested whether providing short-run incentives can create habit formation in children. Over a 3- or 5-week period, students received an incentive (a token worth $0.25 that could be used at school store, carnival or book fair) for eating a serving of fruits or vegetables...

NEJM Catalyst Event Tackles Patient Behavior Change

Feb. 27, 2016

Editor’s note: Last week, NEJM Catalyst and the University of Pennsylvania Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute (LDI CHIBE) hosted a live event and webcast on “Patient Engagement: Behavioral Strategies for Better Health.” In it, event Chair Kevin Volpp described the successful health system of the future that would feature  value-based provider payments and

Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care

Feb. 17, 2016

Ezekiel Emanuel, Peter Ubel, Judd Kessler, Ralph Muller, Amol Navathe, Pankaj Patel, Robert Pearl, Meredith Rosenthal, Lee Sacks, Aditi Sen, Paul Sherman, Kevin Volpp

In Annals of Internal Medicine, Ezekiel Emanuel and colleagues, including Judd Kessler, Ralph Muller, Amol Nayathe, and Kevin Volpp, discuss several principles of behavior economics, including inertia, loss aversion, choice overload, and relative social ranking. Designing physician incentives based on behavioral economics principles can improve their effectiveness through better alignment with performance goals. The study includes anecdotal examples of successful incentive programs that apply behavioral economics principles. Though the effectiveness of behavioral economic-based...

A behavioral economics intervention to increase pertussis vaccination among infant caregivers: A randomized feasibility trial

Feb. 17, 2016

Alison Buttenheim, Alexander Fiks, Randall Burson, Eileen Wang, Susan Coffin, Joshua Metlay, Kristen Feemster

In Vaccine, Alison Buttenheim and colleagues, including Alexander Fiks and Kristen Feemster, evaluate the feasibility and impact of interventions informed by behavioral economics to increase Tdap vaccination among caregivers of young infants. Participants were randomly assigned to one of four conditions: discount voucher, free voucher, informational support and no informational support. Tdap vaccination was assessed by tracking voucher redemption and following up with participants by phone. Only 1 subject out of a total of 95 participants redeemed the retail pharmacy Tdap voucher...

Move It Or Lose It

Feb. 16, 2016

The latest study by LDI Senior Fellow Mitesh Patel and colleagues adds to our growing understanding of how best to frame financial incentives to encourage healthy behaviors, and employer wellness managers should take note.