Behavioral Economics: Evaluation of a Rewards Program for Preventive Care

描述（由申请人提供）：《平价医疗法案》增加了预防性医疗服务的覆盖范围，但研究表明，取消自付费用只会对建议使用和实际使用之间的差异产生有限的影响。患者激励已被推广为一种机制，以增加接受预防性护理。行为经济学领域表明，个人的常规决策和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。这些都是预防性保健的核心特征，也是为什么个人获得预防性保健的可能性低于（同样有效的）治疗性服务的原因。结合行为经济学见解的激励计划可能会更成功，尽管在这方面的经验有限。在南非、美国、英国和中国开展业务的健康保险公司Discovery率先推出了一项不同寻常的创新预防保健激励计划，该计划结合了行为经济学的许多经验教训。在他们的计划中，获得预防保健服务“赚取”积分，然后这些积分可以用于购买折扣旅游和零售商品等礼品。这些类型的激励方案具有显著的潜力，以提高预防保健，但没有实证评估其影响。我们提议的项目将分析这些设计特征是否会增加预防性服务的使用，并评估这对健康保险公司来说是否可能是一种具有成本效益的方法。我们将重点分析美国预防工作组提出的建议。我们的主要统计方法是一种差中差分析（与对照组相比，个人有资格获得新福利的前后情况，即个人只有健康保险，但不参加奖励计划）。

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.