Behavioral nudges are everywhere: calorie counts on menus, automated text reminders to encourage medication adherence, a reminder bell when a driver's seatbelt isn't fastened. Designed to help people make better health choices, these reminders have become so commonplace that they often go unnoticed. InNudging Health, forty-five experts in behavioral science and health policy from across academia, government, and private industry come together to explore whether and how these tools are effective in improving health outcomes.
Behavioral science has swept the fields of economics and law through the study of nudges, cognitive biases, and decisional heuristicsbut it has only recently begun to impact the conversation on health care. Nudging Healthwrestles with some of the thorny philosophical issues, legal limits, and conceptual questions raised by behavioral science as applied to health law and policy. The volume frames the fundamental issues surrounding health nudges by addressing ethical questions. Does cost-sharing for health expenditures cause patients to make poor decisions?
Is it right to make it difficult for people to opt out of having their organs harvested for donation when they die? Are behavioral nudges paternalistic? The contributors examine specific applications of behavioral science, including efforts to address health care costs, improve vaccination rates, and encourage better decision-making by physicians. They wrestle with questions regarding the doctor-patient relationship and defaults in healthcare while engaging with larger, timely questions of healthcare reform.
Nudging Healthis the first multi-voiced assessment of behavioral economics and health law to span such a wide array of issuesfrom the Affordable Care Act to prescription drugs.
Contributors: David A. Asch, Jerry Avorn, Jennifer Blumenthal-Barby, Alexander M. Capron, Niteesh K. Choudhry, I. Glenn Cohen, Sarah Conly, Gregory Curfman, Khaled El Emam, Barbara J. Evans, Nir Eyal, Andrea Freeman, Alan M. Garber, Jonathan Gingerich, Michael Hallsworth, Jim Hawkins, David Huffman, David A. Hyman, Julika Kaplan, Aaron S. Kesselheim, Nina A. Kohn, Russell Korobkin, Jeffrey T. Kullgren, Matthew J.B. Lawrence, George Loewenstein, Holly Fernandez Lynch, Ester Moher, Abigail R. Moncrieff, David Orentlicher, Manisha Padi, Christopher T. Robertson, Ameet Sarpatwari, Aditi P. Sen, Neel Shah, Zainab Shipchandler, Anna D. Sinaiko, Donna Spruijt-Metz, Cass R. Sunstein, Thomas S. Ulen, Kristen Underhill, Kevin G. Volpp, Mark D. White, David V. Yokum, Jennifer L. Zamzow, Richard J. Zeckhauser
Acknowledgments Introduction Christopher T. Robertson, I. Glenn Cohen, and Holly Fernandez Lynch 1. Behaviorally Informed Health Policy? Patient Autonomy, Active Choosing, and Paternalism Cass R. Sunstein 2. Three Choice Architecture Paradigms for Healthcare Policy Russell Korobkin 3. Can Behavioral Economics Save Healthcare Reform? Alan M. Garber 4. Seven Ways of Applying Behavioral Science to Health Policy Michael Hallsworth Part I. The Ethics of Nudges in Healthcare Introduction I. Glenn Cohen 5. What Can PPACA Teach Us About Behavioral Law & Economics? David A. Hymen and Thomas S. Ulen 6. Bad Medicine: Does the Unique Nature of Healthcare Decisions Justify Nudges? Mark D. White 7. Nudging and Benign Manipulation for Health Nir Eyal 8. The Political Morality of Nudges in Healthcare Jonathan Gingerich Part II. Nudging and Public Health Policy Introduction Holly Fernandez Lynch 9. An Ethical Framework for Public Health Nudges: A Case Study of Incentives as Nudges for Vaccination in Rural India Jennifer Blumenthal-Barby, Zainab Shipchandler, and Julika Kaplan 10. Behavioral Economics and Food Policy: The Limits of Nudging Andrea Freeman
Part III: Behavioral Economics and Healthcare Costs Introduction Matthew J.B. Lawrence 11. Cost-Sharing as Choice Architecture Christopher T. Robertson 12. Using Behavioral Economics to Promote Physicians' Prescribing of Generic Drugs and Follow-On Biologics: What Are the Issues? Ameet Sarpatwari, Niteesh K. Choudhry, Jerry Avorn, and Aaron S. Kesselheim 13. Towards Behaviorally Informed Policies for Consumer Credit Decisions in Self-Pay Medical Markets Jim Hawkins
Part IV. Crowding-Out Introduction Neel Shah 14. Extrinsic Incentives, Intrinsic Motivation, and Motivational Crowding-Out in Health Law and Policy Kristin Underhill 15. Do Financial Incentives Reduce Intrinsic Motivation for Weight Loss?: Evidence from Two Tests of Crowding-Out Aditi P. Sen, David Huffman, George Loewenstein, David A. Asch, Jeffrey T. Kullgren, and Kevin G. Volpp
Part V. Behavioral Economics and the Doctor-Patient Relationship Introduction Aaron S. Kesselheim 16. Affective Forecasting in Medical Decision-Making: What Do Physicians Owe Their Patients? Jennifer L. Zamzow 17. Behavioral Economics in the Physician-Patient Relationship: A Possible Role for Mobile Devices and Small Data Alexander M. Capron and Donna Spruijt-Metz 18. The Perilous Promise of Privacy: Ironic Influences on Disclosure of Health Information Ester Moher and Khaled El Emam
Part VI. Deciding for Patients and Letting Patients Decide for Themselves Introduction Christopher T. Robertson 19. Procedural Justice by Default: Addressing Medicare's Backlog Crisis Matthew J.B. Lawrence 20. Measuring the Welfare Effects of a Nudge: A Different Approach to Evaluating the Individual Mandate Manisha Padi and Abigail R. Moncrieff 21. Better Off DeadPaternalism and Persistent Unconsciousness Sarah Conly 22. Improving Healthcare Decisions Through a Shared Preferences and Values Approach to Surrogate Selection Nina A. Kohn 23. Consumer Protection in Genome Sequencing Barbara J. Evans Part VII. Defaults in Healthcare Introduction Gregory Curfman 24. Forced to Choose Again: The Effects of Defaults on Individuals in Terminated Health Plans Anna D. Sinaiko and Richard J. Zeckhauser 25. Presumed Consent to Organ Donation David Orentlicher List of Contributors Index
""Forty-five experts in behavioural science and health policy from across academia, government, and private industry have contributed to this reader.""
