A physician wrote a piece in the New York Times recently that is very relevant to our mission and work here at CHIL. Dr. Khullar writes that years of medical and scientific education often do not influence his decisions as much as his patients’ habits and environmental cues. If anything, a decade of diverse and intense training has made him more attuned to noticing subtle “nudges” and cues that incentivizes him to provide the best care he can, or incentivize his patients to be proactive about their health care.
According to Dr. Khullar, the field of behavioral economics holds that “human decision-making [often] departs” from what might be expected if agents behaved “rationally.” This description seems to characterize medical care as well, where all sorts of factors (emotions and uncertainties, for example) can complicate medical decisions. Despite this connection, Dr. Khullar says that members of the medical community have “only recently” begun exploring how behavioral economics can improve health. This is a crucial change, since medical experts bear an enormous responsibility in how they present care options to patients and how they encourage patients to pursue treatment options. For example, the framing of default options as opt-in or opt-out can have a huge impact on how healthcare is delivered to patients.
Pioneers in linking behavioral economics, decision-making, and medical care are focusing on designing randomized trials or applications to tackle some of the basic, and difficult, challenges in healthcare. Dr. Khullar names some of these challenges as encouraging doctors to provide evidence-based care, incentivizing patients to take their medications (a form of preventative care), and aiding consumers in choosing better health plans that were more comprehensive for their needs. Innovators are also using these challenges as opportunities to create applications to, for example, reward patients for submitting pictures of themselves taking medications each day. These designers create program infrastructures that reward patients for weight loss goals they establish by entering them into lotteries or deposit contracts. Health insurers are jumping onto this wagon as well, and researching goals for patients and doctors to meet when it comes to diseases like diabetes management.
The title of the New York Times piece is “How Behavioral Economics Can Produce Better Health Care.” This title leaves out some crucial actors in the study and delivery of a marriage between behavioral economics and health research. Doctors, patients, and economists each play a distinct role in identifying and acting on potential improvements in healthcare delivery. Projects like the ones we have at CHIL are designed with students as patients in mind - behavioral economics isn’t only for economists! We can all use a project-oriented approach to improve our health.