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，消除自付费用对建议使用与实际使用之间的差异的影响有限。患者激励措施已作为一种增加预防性护理接受度的机制得到推广。行为经济学领域表明，个人通常以可预测的方式做出的决策偏离了新古典经济学的假设。当选择复杂、涉及不确定性或涉及当前和未来成本/收益之间的权衡时，做出正确的决策变得特别困难。这些是预防性护理的核心特征，也是为什么个人获得预防性护理的可能性低于（同样有效的）治疗性服务的原因。尽管经验有限，但结合行为经济学见解的激励计划可能会更成功。 Discovery 是一家在南非、美国、英国和中国开展业务的健康保险公司，首创了一项异常创新的预防性护理激励计划，该计划融合了行为经济学的许多经验教训。在他们的计划中，接受预防性护理服务可以“赚取”积分，然后这些积分可以用于购买折扣旅行和零售商品等礼物。这些类型的激励计划具有改善预防保健的巨大潜力，但尚未对其影响进行实证评估。我们提出的项目将分析这些设计特征是否会增加预防服务的使用，并评估这对于健康保险公司来说是否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双重差异分析（个人有资格获得对照组新福利的前/后，即个人仅拥有健康保险，但不参与奖励计划）。 公共卫生相关性：该项目将评估一项解决医疗保健改革关键问题的计划：我们如何以具有成本效益的方式增加预防性服务的使用？国际健康保险公司 Discovery 制定了一项奖励计划，会员可以通过预防性服务赚取积分，这些积分可以从零售商处兑换各种商品和服务。其他行业也使用了类似类型的奖励/忠诚度计划（从航空公司开始），他们发现与改变价格相比，这是改变客户行为更具成本效益的方式。通过研究该计划成员和对照组的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量人群中可以实现的效果的实证结果。

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.