Behavioral Economics: Evaluation of a Rewards Program for Preventive Care

描述（由申请人提供）：《平价医疗法案》增加了预防性卫生服务的覆盖面，但研究表明，取消自付费用对建议和实际使用之间的差异影响有限。作为一种增加预防性护理的机制，对病人的奖励措施得到了推广。行为经济学领域表明，个人的决策通常以可预测的方式偏离了新古典经济学的假设。当选择很复杂，涉及不确定性，或者涉及当前和未来成本/收益之间的权衡时，做出好的决策变得特别困难。这些都是预防保健的核心特征，也是为什么个人获得预防保健的可能性低于（同样有效的）治疗服务的原因。结合了行为经济学的见解的激励计划可能会更成功，尽管经验有限。一家在南非、美国、英国和中国经营的健康保险公司Discovery率先推出了一项不同寻常的创新性预防保健激励计划，该计划融合了行为经济学的许多教训。在他们的计划中，接受预防保健服务“赚取”积分，这些积分可以用于购买折扣旅游和零售商品等礼品。这些类型的激励计划有显着的潜力，以改善预防保健，但一直没有经验的影响评估。我们提出的项目将分析这些设计功能是否增加了预防服务的使用，并评估这是否是一个具有成本效益的方法，为健康保险公司。我们将重点分析美国预防工作队提出的建议。我们的主要统计方法是差异中的差异分析（个人有资格获得新福利的前/后与对照组，即个人只有健康保险，但没有参加奖励计划）。 公共卫生相关性：这个项目将评估一个解决医疗保健改革中一个关键问题的计划：我们如何以一种具有成本效益的方式增加预防服务的使用？国际健康保险公司Discovery开发了一个奖励计划，会员可以获得预防服务的积分，这些积分可以从零售商那里换取各种商品和服务。类似类型的奖励/忠诚度计划已被用于其他行业（从航空公司开始），他们发现这是一种比改变价格更经济有效的方式来改变客户行为。通过研究该计划成员和对照组之间预防服务利用和健康结果的变化，我们将能够提供基于行为经济学最新思想的计划在大规模人群中可以实现的实证结果。

DESCRIPTION (provided by applicant): The Affordable Care Act increased coverage for preventive health services, but research has shown that removing out-of-pocket costs will only have a limited impact on the discrepancy between recommended and actual use. Patient incentives have been promoted as a mechanism to increase receipt of preventive care. The field of behavioral economics demonstrates that individuals' decision making routinely and in predictable ways deviates from assumptions underlying neoclassical economics. Making good decisions becomes particularly hard when choices are complex, involve uncertainty, or involve tradeoffs between current and future costs/ benefits. These are central features of preventive care and contribute to why individuals are less likely to obtain preventive care than (similarly effective) curative services. Incentive programs that incorporate insights from behavioral economics may be more successful, although experience with them is limited. An unusually innovative preventive care incentive program that incorporates many of the lessons of behavioral economics has been pioneered by Discovery, a health insurance company operating in South Africa, the United States, the UK, and China. In their program, the receipt of preventive care services "earns" points and the points can then be used for gifts such as discounted travel and retail items. These types of incentive programs have significant potential to improve preventive care, but there have been no empirical evaluations of their impact. Our proposed project will analyze whether these design features increase the use of preventive services and evaluate whether this could be a cost-effective approach for a health insurer. We will focus our analysis upon recommendations made by the U.S. Preventive Task Force. Our primary statistical approach is a difference-in- difference analysis (pre/post of individuals becoming eligible for new benefits with control groups, i.e. individual only having health insurance, but not participating in the reward program). PUBLIC HEALTH RELEVANCE: This project will evaluate a program that addresses a key issue in health care reform: How can we increase use of preventive services in a cost-effective way? Discovery, an international health insurance company, developed a reward program in which members earn points for preventive services that can be exchanged for a variety of goods and services from retailers. Similar types of reward/loyalty program have been used in other industries (starting with airlines), who found it a more cost-effective way to change customer behavior than changing prices. By studying changes in utilization of preventive services and health outcomes among this program's members and a control group, we will be able to provide the empirical results on what a program based on recent ideas from behavioral economics could achieve in a large population.