• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to secondary sidebar
  • Skip to footer

  • Opinion
  • Health IT
    • Behavioral Health
    • Care Coordination
    • EMR/EHR
    • Interoperability
    • Patient Engagement
    • Population Health Management
    • Revenue Cycle Management
    • Social Determinants of Health
  • Digital Health
    • AI
    • Blockchain
    • Precision Medicine
    • Telehealth
    • Wearables
  • Life Sciences
  • Investments
  • M&A
  • Value-based Care
    • Accountable Care (ACOs)
    • Medicare Advantage

Is Behavioral Economics in Healthcare The Key to Future Patient Compliance?

by Irv Lichtenwald , CEO of Medsphere Systems Corporation 10/16/2018 Leave a Comment

  • LinkedIn
  • Twitter
  • Facebook
  • Email
  • Print

Medsphere CEO Talks Affordable Healthcare IT and Future of EHRs

In 2009, mostly to fund the State Children’s Health Insurance Program, the U.S. government increased the tax on cigarettes from 39 cents to a $1.01. What followed was a demonstration of what we now commonly call behavioral economics.

When taxes drove the price of cigarettes up, teenage smoking rates fell 10 percent, according to the Campaign for Tobacco-Free Kids, and overall smoking dropped more than 8 percent, the most significant dip in smoking since 1932. The increase-taxes approach to cigarettes is now commonly used in all 50 states as a means of both generating revenues and reducing the number of smokers. Indeed, policy success has led to similar suggestions regarding soda as diabetes rates across the country skyrocket.

In this way, behavioral economics, for which Richard Thaler won the 2017 Nobel Prize in economics, has wormed its way into the fabric of our lives, creating more focus on incentives and disincentives as engines of behavioral change.

Here’s one more example: People usually choose bananas over oranges because the latter takes more effort to peel, illustrating the idea that making one path easier and another more difficult effectively directs personal behavior.

And here’s another: Savings rates are much higher when employees have to opt out of automatic deduction plans than when they are asked to opt in.

And yet, while the evidence of efficacy in behavioral economics seems strong generally, it’s relatively weak in healthcare.

New York Times reporter Aaron Carroll cites efforts to nudge recent heart attack sufferers to regularly take their medications, a non-activity that causes roughly 100,000 preventable deaths annually. (Yes, common sense might suggest that the heart attack alone should be sufficient motivation, but that would require a long conversation about what qualifies as sense and how common it really is.)

“Getting patients to change their behavior is very hard,” Carroll writes. “In the past, we’ve tried making drugs free to patients to get them to adhere to their medications and improve outcomes. That failed. We’ve tried lotteries … to nudge people to achieve better compliance. That failed.

“Maybe financial incentives, and behavioral economics in general work better in public health than in more direct health care.”

Indeed, we can be confident that behavioral economics works well in many settings, including public health. Besides the smoking cessation example, people donate organs more often when it’s the default.

But they don’t take their pills, even when a study includes the “kitchen-sink approach … direct financial incentives, social support nudges, health care system resources and significant clinical management.”

As some are now suggesting, the reason for this seemingly illogical behavior might come down to elegance, i.e., the beauty of behavioral economics is its simple elegance in so many situations, but many behavioral scenarios are anything but elegant, especially healthcare.

“Nudging in healthcare is rooted in the erroneous assumption that self-defeating health behaviors are necessarily irrational,” writes the Christensen Institute’s Rebecca Fogg. “This assumption ignores the inconvenient truth that people and their lives are complex, so their barriers to healthy behavior are, too.”

Given that complexity, Fogg and colleagues at the Christensen Institute have developed an alternative model called Job Theory that they feel takes human complexity into account.

As Clayton Christensen, Fogg and Andrew Waldeck write in a white paper:

“Jobs Theory explains that everything people consciously choose to do (including doing nothing), they do to make progress according to their own priorities, in a particular set of circumstances. We call this progress a ‘job,’ and it motivates individuals to search for solutions. Based on this insight, the theory asserts that the way to unleash patients’ potential to better manage their health is not to try to get them to prioritize health goals over the jobs they’re already striving to do. Instead, it’s to understand those jobs, and help patients accomplish them in ways that enhance their health, rather than detract from it.”

At the heart of Jobs Theory is healthcare delivery animated by five core characteristics:

·       Takes into account patients’ full capacity to change

·       Works with patients’ existing belief about health

·       Illuminates the broader determinants of individual health status

·       Clarifies the real competition to healthy behavior

·       Shifts units of performance from outcomes to progress

So, is Jobs Theory somehow a replacement for behavioral economics, at least in the realm of healthcare? No, it isn’t. Indeed, Jobs Theory may never have been imagined without the insights created by behavioral economics. And, arguably, neither would be realizable without the healthcare IT tools now available for monitoring, reminders, etc.

“The application of behavioral economics to healthcare is indicative of an exciting movement to bring new science and technology to some of society’s most serious and persistent problems,” writes Fogg. “As such, innovators should continue to explore its capabilities—but also its limits. Because when it comes to adopting healthy behaviors, it’s not always a nudge that people need.”

No, sometimes it’s a kick in the pants. And sometimes it’s a regular alert on a cell phone. In the context of broader pushes for value-based payments and personalized care, the next step is to develop a methodology for determining who needs the nudge, who needs the kick and who needs a little of everything.

 

Irv Lichtenwald is president and CEO of  Medsphere Systems Corporation, the solution provider for the CareVue electronic health record.

  • LinkedIn
  • Twitter
  • Facebook
  • Email
  • Print

Tap Native

Get in-depth healthcare technology analysis and commentary delivered straight to your email weekly

Reader Interactions

Primary Sidebar

Subscribe to HIT Consultant

Latest insightful articles delivered straight to your inbox weekly.

Submit a Tip or Pitch

Featured Interview

Reach7 Diabetes Studios Founder Chun Yong on Reimagining Chronic Care with a Concierge Medical Model

Most-Read

HHS Finalizes HTI-4 Rule: Prior Authorization & E-Prescribing Interoperability

HHS Finalizes HTI-4 Rule: Prior Authorization & E-Prescribing Interoperability

Meaningful Use Penalties_Meaningful Use_Partial Code Free_Senators Urge CMS to Establish Clear Metrics for ICD-10 Testing

CMS Finalizes TEAM Model: A New Era of Value-Based Surgical Care

White House Event Unveils CMS Health Tech Ecosystem Initiative

White House Event Unveils CMS Health Tech Ecosystem Initiative

Digital Health Faces Q2'25 Pullback: Funding Falls to 5-Year Low, But AI Dominates and $1B+ IPOs Emerge

Healthcare Investment Shifts in 1H 2025: AI Remains a Bright Spot Amidst Fundraising Decline

Digital Health Faces Q2'25 Pullback: Funding Falls to 5-Year Low

Digital Health Faces Q2’25 Pullback: Funding Falls to 5-Year Low

Beyond the Hype: Building AI Systems in Healthcare Where Hallucinations Are Not an Option

Beyond the Hype: Building AI Systems in Healthcare Where Hallucinations Are Not an Option

Health IT Sector Navigates Policy Turbulence with Resilient M&A

Health IT’s New Chapter: IPOs Return, Resilient M&A, Valuations Rise in 1H 2025

PwC Report: US Medical Cost Trend to Remain Elevated at 8.5% in 2026

PwC Report: US Medical Cost Trend to Remain Elevated at 8.5% in 2026

Philips Launches ECG AI Marketplace, Partnering with Anumana to Enhance Cardiac Care with AI-Powered Diagnostics

Philips Launches ECG AI Marketplace, Partnering with Anumana to Enhance Cardiac Care with AI-Powered Diagnostics

WeightWatchers Emerges from Bankruptcy, Launches New Menopause Program

WeightWatchers Emerges from Bankruptcy, Launches New Menopause Program

Secondary Sidebar

Footer

Company

  • About Us
  • Advertise with Us
  • Reprints and Permissions
  • Submit An Op-Ed
  • Contact
  • Subscribe

Editorial Coverage

  • Opinion
  • Health IT
    • Care Coordination
    • EMR/EHR
    • Interoperability
    • Population Health Management
    • Revenue Cycle Management
  • Digital Health
    • Artificial Intelligence
    • Blockchain Tech
    • Precision Medicine
    • Telehealth
    • Wearables
  • Startups
  • Value-Based Care
    • Accountable Care
    • Medicare Advantage

Connect

Subscribe to HIT Consultant Media

Latest insightful articles delivered straight to your inbox weekly

Copyright © 2025. HIT Consultant Media. All Rights Reserved. Privacy Policy |