6 Strategies for Incorporating Behavioral Economics in Your Practice

6 Strategies for Incorporating Behavioral Economics in Your Practice 150 150 Kevin Mayhood

Behavioral economics combines insights from psychology, economics and marketing to improve or direct decision-making. It can be used to “nudge” patients, their families and practitioners in the direction of better health if used by health care providers. While the use of behavioral economics strategies has limited study in pediatrics, the existing research indicates a number of types of nudges may be effective.

In considering how simple incentives may nudge patients, caregivers and clinicians to make more healthful choices, Jack Stevens, PhD, a clinical psychologist and principal investigator in the Center for Biobehavioral Health at Nationwide Children’s Hospital, and Charlene Wong, MD, assistant professor of pediatrics and a health services/health policy researcher at Duke University, share six strategies used in implementing behavioral economics.

1. Opt-in, opt-out

As a general rule, fewer people opt-in to a plan or program compared to the number who stay the course when change requires them to opt-out of the same plan or program. For example, when parents are asked by a pediatrician during a routine visit, “What do you want to do about shots today?” more choose not to have their child vaccinated than when a pediatrician said to parents, “We have shots we need to do today,” Dr. Stevens says.

The strategy, however, didn’t work among adults who were due for a colonoscopy. Patients who were contacted and asked to call and make an appointment had a better show rate than those who were told they’d been prescheduled for the procedure on a certain day and time. “It may be too personal a procedure for opt-out to work,” Dr. Stevens says.

2. Loss aversion

People are more likely to act to prevent the loss of something of value than they are to act to gain the identical something of value, whether cash, objects or privileges, Dr. Wong says.

A number of  studies show that patients offered a daily or weekly payment if they reach their goals — such as checking their insulin regularly or meeting weight-loss targets — were less likely to meet those goals than if the same amount of money were put in a pot and the patient could only withdraw the cash if they met their goal. Otherwise, they’d “lose” the money.

3. Social incentives

What peers may think can be a powerful influence. In a study used to decrease inappropriate antibiotic prescriptions, published in the Journal of the American Medical Association, physicians were immediately warned that the prescription they’d written may be inappropriate. Then, they were asked to write an explanation for the prescription, knowing other clinicians might see the medical record. This combination of nudges decreased the likelihood that the clinician would prescribe an inappropriate antibiotic.

4. Personal perception

People tend to perceive themselves as both above average in most things in life and luckier than average, which reflects the desire to be both, Dr. Stevens says, and creates opportunities for behavioral economics.

A study aimed at reducing electricity usage found the message has to be different for consumers who use more than average and those who use less. Above average consumers informed they were using more electricity than their neighbors cut back but below average consumers informed they were using less than neighbors tended to slip and use more. Below average users who received a smiley-face icon on their electric bill didn’t change consumption.

People’s perception that they’re more likely to win a lottery than the mathematical odds of winning paid off in at least one study. Adults who were told they could qualify for prize money completed a health risk assessment at higher rates than those given a sure but lower payment.

Considering the research in adults, how could using these strategies to nudge children and adolescents work?

“The brain development of children and particularly adolescents is different from adults,” Dr. Wong says. “Their reactions to risk and reward are different … these interventions may be more potent for them than for older people.”

5. Compromise effect

Consumers generally eschew the highest and lowest priced models of an item and buy something in the middle or, in some cases, the less expensive of two items. Based on that, Williams-Sonoma boosted sales of its $280 bread-maker by adding a $400 model to its catalog and Xerox boosted the sales of a high-volume copier after bringing out a more expensive model.

The strategy also holds promise with patients. Dr. Stevens works with adolescents with sleep disorders, and he tells teens they can either give up caffeine or only drink it in the morning. He knows either option works, but by not forcing one or the other, he’s found that kids appear to feel good about rejecting the first option, choose the second and comply.

6. Present choices in a simpler and smarter way

When families are given too many rules to follow, too many options or just too much information, they mayforget to do what’s most important for their child, Dr Stevens says. This is a case where less can be more, he says.

Hundreds of thousands of families in the United States fail to follow safe sleeping guidelines for their infants. Rather than give them a list of a dozen or more things they can do to prevent SIDS — which may overwhelm the family— give them a few simple rules Dr. Stevens says. Rules, such as the ABCs, which stands for alone, on the back and in a crib, are easy to remember and follow.

When complex issues can’t be easily simplified, a high number of choices reduced or both, the order of presentation matters, Dr. Wong says. Just as election studies show that people tend to vote for names at the top of a long ballot, “We’ve found that the order in which health insurance plans are presented affects choice,” she says. Consider putting the most beneficial choices for parent, patients or clinicians at the top of the list, she said.


  1. Stevens J. The promising contributions of behavioral economics to quality improvement in health carePediatric Quality and Safety. 2017 May/Jun;2(3): e023.
  2. Meeker D, Linder JA, Cox CR, Friedberg MW, Persell SD, Goldstein NJ, Knight TK, Hay JW, Doctor JN. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: A randomized clinical trialJournal of the American Medical Association. 2016 Feb 9;315(6): 562-570.

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