Center for Health Incentives and Behavioral Economics News Archive

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Scott Halpern Wins Alice S. Hersh New Investigator Award

Dr. Halpern, Deputy Director of CHIBE, was recognized at AcademyHealth's Annual Research Meeting for demonstrating exceptional promise for future contributions to the field of health services research. Among other important contributions to the fields of health services research, epidemiology and medical ethics, Dr. Halpern's research on default options in patient decision making has advanced the field of behavioral economics applied to health and health care. 

Wellness Incentive Programs Gaining Popularity Among Employers and States

In the U.S., there are high rates of preventable diseases and, until recently, little focus on prevention. However, employers can keep health care costs down by implementing effective incentives programs, explained Kevin Volpp during an invited panel appearance in Sacramento, CA. 

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Fairness, Effectiveness, and the Likelihood of States Levying Fines on Medicaid Recipients Who Smoke or Are Obese

Katherine Milkman and Kevin Volpp have slightly different perspectives on whether an Arizona proposal to penalize Medicaid recipients who are obese or smoke with a $50 fine is fair or potentially effective, but both agree that something like it could be enacted. 

Brain Chemistry, Financial Incentives, and Resolutions

Washington Post article about doomed New Year’s resolutions outlined how dopamine pathways in the brain establish reward systems that make habits difficult to break. Rewards for actions are critical to establishing habits, suggesting that financial incentives might be a useful tool to change behaviors. Invited to comment, Kevin Volpp noted that environmental factors also play an important role in health behaviors. In citing his research among GE employees, which demonstrated that paying smokers to quit increased the number of successful quitters, and a similar project aimed at weight-loss that showed no difference between those who were paid and those who were not, Volpp explained that while smoking in public is becoming more difficult, high-calorie low-cost food is ubiquitous and easily obtained.

Tags: Kevin Volpp

Are Wellness Incentives Fair?

Source:  Los Angeles Times, January 3, 2011

That was the question in a debate-style piece from the Los Angeles Times. According to Harold Schmidt, a Harkness Fellow at Harvard University, incentive programs to improve health behaviors are a good idea but poor implementation could lead to inequities, particularly if the incentive program is structured in a way that does not allow everyone equal potential for success. On the other hand, CHIBE Director Kevin Volpp conceded that while more research into optimal implementation is needed, wellness incentives have been shown to help people quit smoking and he proposed that such programs can help to align patients, employers and insurers toward the same goal: healthy patients.

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Incentives Can Help Teens Lose Weight

Work by LDI CHI researchers Kevin Volpp and others was cited in a news article regarding a study led by a group of researchers at Temple University that found that among teens enrolled in a weight-loss program administered by medical students, 52.6 percent who received financial incentives were able to meet a 16-pound weight loss goal while only 10.5 percent of teens in the group that did not receive incentives were able to lose the 16 pounds

Tags: Kevin Volpp

Imagined Eating Reduces Actual Food Consumption

Carey Morewedge, Co-investigator at the Penn-CMU Roybal Center on Behavioral Economics at CHIBE, recently published an article in Science demonstrating that research participants who imagined eating large quantities of particular foods (cheese and M&Ms) ate less of the food than other research participants who did not engage in the imaginary consumption exercise. Morewedge attributes the effect to habituation -- the human capacity to adjust to particular stimuli, be it bright lights, smells or the food we are eating -- though more research is needed to understand the effect before it is adopted as a dieting strategy

Pay Some Now or Pay More Later

Invited to comment in a summary article on the use of financial incentives to change health behaviors, Kevin Volpp noted that it is less expensive to pay someone to quit smoking now than to pay for emphysema treatment for a long-term smoker. He also noted that more research is needed to determine the optimal use of financial incentives to change health behaviors.

Tags: Kevin Volpp

High-Deductible Health Plans (HDHPs) Reduce Consumer Health Care Use, but Decisions Based On Cost Alone May Not Be Healthy

Jeff Kullgren’s recent article in the Archives of Internal Medicine showed that among HDHP enrollees in New England, lower-income families were more likely than higher-income families to report delaying or forgoing health care, although both groups engaged in the behavior. Based on Kullgren’s findings the New York Times opened a discussion about whether consumers who share medical costs have enough knowledge to make health care decisions, while National Public Radio reported that Kullgren’s work echoed results from an older study showing that HDHPs will have a disproportionate impact on the poor. In local coverage, the Philadelphia Inquirer mentioned an accompanying Archives commentary about “value-based insurance design,” which might be a healthier option than HDHPs.

Ice Cream Now, Broccoli Later

Katherine Milkman's research exploring online consumer grocery purchasing habits reveals that generally, the sooner people took delivery of their groceries, the less healthy and more expensive the order and that orders placed for delivery farther in the future contained more healthy items and cost less. "Spending decreases as we order food further in the future, but the more immediate the gratification, the more freely we spend," says Milkman.

Karen Glanz, PhD, MPH: Researcher, Teacher, Public Health Advocate, and Triathlete

A lengthy Q&A profiles the CHIBE affiliated faculty member, a Penn Integrates Knowledge (PIK) Professor appointed to the Medical and Nursing Schools, who was recently named George A.Weiss University Professor and director of Penn’s Center for Health Behavior Research.

Tags: Karen Glanz

Behavioral Economics in Action: Physicians Easily Persuaded to Rationalize Industry Gifts

In research by Sunita Sah and and CHIBE Associate Director George Loewenstein published in the September 15, 2010 issue of the Journal of the American Medical Association, three groups of medical residents received different online surveys. Among the physicians who were reminded of the sacrifices made in obtaining their medical education, twice as many deemed industry gifts acceptable in comparison to the control group. Among the medical residents who were exposed to a suggested rationalization for accepting industry gifts, the number who perceived gifts to be acceptable rose to 60.3%, despite the majority reporting that they disagreed with the rationalization. Lowenstein, in comments to the Wall Street Journal Health Blog, noted that, given the documented increases industry gifts have on prescribing and the "remarkable human ability to rationalize when inducements are high enough,” such conflicts of interest ought to be eliminated.

Finding the Sweet Spot: Only Well-Structured Incentive Programs In the Right Amount Improve Health Behaviors

Kevin Volpp and others, including Art Caplan, discuss various approaches to improving smoking cessation, weight loss, and other health behaviors.

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New Health Incentives Programs Need to Follow up With Evaluation

Anticipating growth in the use of incentive programs to improve health behavior, the American College of Physicians issued relevant guidelines. Asked to comment on WHYY radio, LDI CHIBE Director Kevin Volpp noted that in addition to following ethical guidelines, newly-developed incentive programs need to measure impact.

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American College of Physicians (ACP) Issues Guidelines on the Use of Incentives to Promote Healthy Behavior

ACP’s position paper examines potential ethical pitfalls of, and suggests strategies to ensure fairness in, the application of behavioral economics approaches to improve health. ACP developed the guidelines in anticipation of increased use of incentive programs as a consequence of the passage of the March 2010 Patient Protection and Affordable Care Act, otherwise known as the health care reform bill.

Massachusetts Pilot Program to Test Rebates for Buying Fresh Vegetables Among Food Stamp Recipients

Source: Boston Globe, August 19, 2010

In a Boston Globe article describing a pilot project designed to test the effectiveness of incentives in boosting fresh fruit and vegetable purchases, CHIBE Director Kevin Volpp commented on the laudable goals of the program. He also noted that the rebate mechanism, which directs funds to the recipients’ cards with no visible evidence of a rebate, may not be tangible enough to influence behavior. 
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Rachel Werner Honored with Presidential Research Award

CHIBE faculty member Rachel Werner will receive a Presidential Early Career Award for Scientists and Engineers (PECASE) for, “conceiving and leading an innovative research program evaluating how clinical performance measurement in the VA and other health systems improves the quality and equity of the care patients receive.” The PECASE is the highest honor bestowed by the US government on outstanding scientists and engineers early in their career and is marked by a ceremony at the White House and a personal presentation by the President.

Behavioral Economics in the Real World with a Research Round-Up

In a wide-ranging interview on the radio program Good Health is Good Business, LDI CHIBE Director Kevin Volpp discusses the application of health incentives in the real world, the need for more research to define the best structures for programs, and the related work of CHIBE investigators George Lowenstein and Scott Halpern.

Replacing Harmful Incentives with Helpful Incentives

Research studies, including studies on smoking cessation and weight loss conducted by CHIBE researchers, have found that financial incentives introduced to promote physical well-being can counter some of the effects of existing incentives that are harmful to health, but Kevin Volpp comments that new strategies need to be devised to improve health in the long-term .

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The Uses of Behavioral Economics

Renowned behavioral economists George Loewenstein and Peter Ubel discuss in an op-ed how behavioral economics can help to improve our understanding of how individuals might react to policies meant to improve the greater good, but, they explain, the field does not encompass fixing the root of the large social problems it is increasingly being called on to address.