Healthcare and Improving Patient s Choices

Economics and Healthcare:

Incentivizing Better Healthcare Choices

Although health is priceless, affording good health and healthcare has grown increasingly costly, particularly in the United States. Stakeholders with an interest in improving both the population’s health while still keeping healthcare costs contained include patients, patient’s families, providers, employers who provide health insurance to employees and wish to keep employees sick days at a minimum, insurance providers, and government policy-makers. Healthcare considerations encompass reducing the pervasiveness of chronic diseases, such as type 2 diabetes, as well as reducing the spread of infectious disease. These concerns are not limited to the current concerns about coronavirus but also the spread of measles, mumps, and other diseases once thought to be eradicated by vaccination.

It is true that economic incentives to encourage good health can be used to promote healthy behavior. These may include techniques using positive and negative reinforcement. In terms of positive reinforcement, offering care at little or no cost, such as subsidized health insurance through the Affordable Care Act (ACA), free vaccines to promote the public good, and free public health screening would all be considered direct economic incentives designed to improve population health, reducing the immediate economic pain to seeking out screening and earl treatment. Negative economic reinforcers include so-called sin taxes upon sugary, high-calorie foods linked to obesity, zoning ordinances prohibiting fast food restaurants from existing within districts at high risk for obesity, and requirements that individuals vaccinate their children or themselves to go to public schools or to participate in the workforce.

According to Hostetter & Klein (2020), in an effort to reduce workplace healthcare costs, many businesses are using behavioral economics to incentivize better behaviors, such as exercising, improved food choices, and smoking cessation. The Affordable Care Act, allows employers to dedicate 30% of employee premium costs to wellness incentive programs (Hostetter & Klein, 2020). Such programs like free gym memberships have shown only modest results, while other, more successful programs have incentivized smaller behavioral changes such as at-work pedometer steps challenges, or even financial rewards based upon health challenges (such as going to the company gym every day (Hostetter & Klein, 2020).

While sometimes it is hypothesized that poor healthcare behavioral adherence is due to a failure of the will or medication side effects, there is also evidence that other factors may be at play. For example, patients being treated for heart disease often have low compliance rates with adhering to their treatment regimes, but in one trial, patients were given a smart pill bottle that tracked their use, wirelessly transmitted them to a database, and enabled them to be entered for a prize if they were found to be compliant (Hostetter & Klein, 2020). This suggests providing immediate short-term tangible rewards is more effective than the use of long-term incentives, such as good health, which can be more difficult to conceptualize.