Dhruv Khullar in the New York Times: “…We in the medical community have only recently started to explore how behavioral economics can improve health. As with any hot field, there’s always the possibility of hype. But these insights might be particularly valuable in health care because medical decision-making is permeated with uncertainty, complexity and emotion — all of which make it hard to weigh our options.
A leader of this movement is Dr. Kevin Volpp, a physician at the University of Pennsylvania and founding director of the Center for Health Incentives and Behavioral Economics. He designs randomized trials around some of health care’s most important challenges: nudging doctors to provide evidence-based care; ensuring patients take their medications; and helping consumers choose better health plans.
“There’s starting to be a broad recognition that decision-making environments in health care could better reflect how doctors and patients actually make decisions,” he said.
Dr. Volpp, whose work is used by both the public and private sector, recently collaborated with CVS Caremark to test which financial incentives are most effective for getting employees to quit smoking. Employees were randomly assigned to one of three groups. The first was “usual care,” in which they received educational materials and free smoking cessation aids. The second was a reward program: Employees could receive up to $800 over six months if they quit. The third was a deposit program, in which smokers initially forked over $150 of their money, but if they quit, they got their deposit back along with a $650 bonus.
Compared with the usual care group, employees in both incentive groups were substantially more likely to be smoke-free at six months. But the nature of the incentives mattered. Those offered the reward program were far more likely to accept the challenge than those offered the deposit program. But the deposit program was twice as effective at getting people to quit — and five times as effective as just pamphlets and Nicorette gum.
Parting with your own money is painful. But it is effective.
That’s also a lesson in Volpp-led research on getting people to lose weight and exercise more. One recent study gave incentives to patients by entering them into lotteries or into deposit contracts for meeting weight loss goals. Those in the lottery group were eligible for a daily lottery prize with frequent small payouts and occasional large rewards — but only if they clocked in at or below their weight loss goal. People in the deposit group invested their own money (generally a few dollars a day), which was then matched by researchers. They’d get their money back — and then some — if they met their goal at the end of the month….(More)”
rking with Change: Systems Approaches to Public Sector Challenges” is now available online. In addition to the framework that was introduced previously on Hackpad, the team working on systems thinking at the Observatory has added four in-depth case studies from Canada, Finland, Iceland and the Netherlands to the analysis. The empirical cases show that systems change in the public sector is possible; moreover, that it can work in diverse settings: child protection in the Netherlands, responding to domestic violence in Iceland, engaging with the sharing economy in Canada, and in experimental policy design in Finland. The final version of the report is expected in June 2017. (