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Nudging Health

Health Law and Behavioral Economics

edited by I. Glenn Cohen, Holly Fernandez Lynch, and Christopher T. Robertson
foreword by Cass R. Sunstein
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A deep look at the role of behavioral "nudges" for improving health.

Winner of the CHOICE Outstanding Academic Title of the Choice ACRL

Behavioral nudges are everywhere: calorie counts on menus, automated text reminders to encourage medication adherence, a reminder bell when a driver’s seatbelt isn’t fastened. Designed to help people make better health choices, these reminders have become so commonplace that they often go unnoticed. In Nudging Health, forty-five experts in behavioral science and health policy from across academia, government, and private industry come together to explore whether...

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A deep look at the role of behavioral "nudges" for improving health.

Winner of the CHOICE Outstanding Academic Title of the Choice ACRL

Behavioral nudges are everywhere: calorie counts on menus, automated text reminders to encourage medication adherence, a reminder bell when a driver’s seatbelt isn’t fastened. Designed to help people make better health choices, these reminders have become so commonplace that they often go unnoticed. In Nudging Health, forty-five experts in behavioral science and health policy from across academia, government, and private industry come together to explore whether and how these tools are effective in improving health outcomes.

Behavioral science has swept the fields of economics and law through the study of nudges, cognitive biases, and decisional heuristics—but it has only recently begun to impact the conversation on health care. Nudging Health wrestles with some of the thorny philosophical issues, legal limits, and conceptual questions raised by behavioral science as applied to health law and policy. The volume frames the fundamental issues surrounding health nudges by addressing ethical questions. Does cost-sharing for health expenditures cause patients to make poor decisions? Is it right to make it difficult for people to opt out of having their organs harvested for donation when they die? Are behavioral nudges paternalistic? The contributors examine specific applications of behavioral science, including efforts to address health care costs, improve vaccination rates, and encourage better decision-making by physicians. They wrestle with questions regarding the doctor-patient relationship and defaults in healthcare while engaging with larger, timely questions of healthcare reform.

Nudging Health is the first multi-voiced assessment of behavioral economics and health law to span such a wide array of issues—from the Affordable Care Act to prescription drugs.

Contributors: David A. Asch, Jerry Avorn, Jennifer Blumenthal-Barby, Alexander M. Capron, Niteesh K. Choudhry, I. Glenn Cohen, Sarah Conly, Gregory Curfman, Khaled El Emam, Barbara J. Evans, Nir Eyal, Andrea Freeman, Alan M. Garber, Jonathan Gingerich, Michael Hallsworth, Jim Hawkins, David Huffman, David A. Hyman, Julika Kaplan, Aaron S. Kesselheim, Nina A. Kohn, Russell Korobkin, Jeffrey T. Kullgren, Matthew J.B. Lawrence, George Loewenstein, Holly Fernandez Lynch, Ester Moher, Abigail R. Moncrieff, David Orentlicher, Manisha Padi, Christopher T. Robertson, Ameet Sarpatwari, Aditi P. Sen, Neel Shah, Zainab Shipchandler, Anna D. Sinaiko, Donna Spruijt-Metz, Cass R. Sunstein, Thomas S. Ulen, Kristen Underhill, Kevin G. Volpp, Mark D. White, David V. Yokum, Jennifer L. Zamzow, Richard J. Zeckhauser

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Reviews

Forty-five experts in behavioural science and health policy from across academia, government, and private industry have contributed to this reader.

— Springer Journal

The wide range of viewpoints represented in Nudging Health is a real strength, one that will enhance the value of the text as a teaching tool. Many of the chapters, which are written by leaders and innovators in the field of behavioral economics and/or legal applications, represent genuinely new arguments and analyses. This superb and timely book is a pleasure to read.

— Jon S. Vernick, Johns Hopkins Bloomberg School of Public Health, coeditor of Reducing Gun Violence in America: Informing Policy with Evidence and Analysis
About

Book Details

Publication Date
Status
Available
Trim Size
6.125
x
9.25
Pages
392
ISBN
9781421421018
DOI
Illustration Description
8 line drawings
Subject
Table of Contents

Acknowledgments
Introduction
Christopher T. Robertson, I. Glenn Cohen, and Holly Fernandez Lynch
1. Behaviorally Informed Health Policy? Patient Autonomy, Active Choosing, and Paternalism
Cass R. Sunstein

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Acknowledgments
Introduction
Christopher T. Robertson, I. Glenn Cohen, and Holly Fernandez Lynch
1. Behaviorally Informed Health Policy? Patient Autonomy, Active Choosing, and Paternalism
Cass R. Sunstein
2. Three Choice Architecture Paradigms for Healthcare Policy
Russell Korobkin
3. Can Behavioral Economics Save Healthcare Reform?
Alan M. Garber
4. Seven Ways of Applying Behavioral Science to Health Policy
Michael Hallsworth
Part I. The Ethics of Nudges in Healthcare
Introduction
I. Glenn Cohen
5. What Can PPACA Teach Us About Behavioral Law & Economics?
David A. Hymen and Thomas S. Ulen
6. Bad Medicine: Does the Unique Nature of Healthcare Decisions Justify Nudges?
Mark D. White
7. Nudging and Benign Manipulation for Health
Nir Eyal
8. The Political Morality of Nudges in Healthcare
Jonathan Gingerich
Part II. Nudging and Public Health Policy
Introduction
Holly Fernandez Lynch
9. An Ethical Framework for Public Health Nudges: A Case Study of Incentives as Nudges for Vaccination in Rural India
Jennifer Blumenthal-Barby, Zainab Shipchandler, and Julika Kaplan
10. Behavioral Economics and Food Policy: The Limits of Nudging
Andrea Freeman

Part III: Behavioral Economics and Healthcare Costs
Introduction
Matthew J.B. Lawrence
11. Cost-Sharing as Choice Architecture
Christopher T. Robertson
12. Using Behavioral Economics to Promote Physicians' Prescribing of Generic Drugs and Follow-On Biologics: What Are the Issues?
Ameet Sarpatwari, Niteesh K. Choudhry, Jerry Avorn, and Aaron S. Kesselheim
13. Towards Behaviorally Informed Policies for Consumer Credit Decisions in Self-Pay Medical Markets
Jim Hawkins

Part IV. Crowding-Out
Introduction
Neel Shah
14. Extrinsic Incentives, Intrinsic Motivation, and Motivational Crowding-Out in Health Law and Policy
Kristin Underhill
15. Do Financial Incentives Reduce Intrinsic Motivation for Weight Loss?: Evidence from Two Tests of Crowding-Out
Aditi P. Sen, David Huffman, George Loewenstein, David A. Asch, Jeffrey T. Kullgren, and Kevin G. Volpp

Part V. Behavioral Economics and the Doctor-Patient Relationship
Introduction
Aaron S. Kesselheim
16. Affective Forecasting in Medical Decision-Making: What Do Physicians Owe Their Patients?
Jennifer L. Zamzow
17. Behavioral Economics in the Physician-Patient Relationship: A Possible Role for Mobile Devices and Small Data
Alexander M. Capron and Donna Spruijt-Metz
18. The Perilous Promise of Privacy: Ironic Influences on Disclosure of Health Information
Ester Moher and Khaled El Emam

Part VI. Deciding for Patients and Letting Patients Decide for Themselves
Introduction
Christopher T. Robertson
19. Procedural Justice by Default: Addressing Medicare's Backlog Crisis
Matthew J.B. Lawrence
20. Measuring the Welfare Effects of a Nudge: A Different Approach to Evaluating the Individual Mandate
Manisha Padi and Abigail R. Moncrieff
21. Better Off Dead—Paternalism and Persistent Unconsciousness
Sarah Conly
22. Improving Healthcare Decisions Through a Shared Preferences and Values Approach to Surrogate Selection
Nina A. Kohn
23. Consumer Protection in Genome Sequencing
Barbara J. Evans
Part VII. Defaults in Healthcare
Introduction
Gregory Curfman
24. Forced to Choose Again: The Effects of Defaults on Individuals in Terminated Health Plans
Anna D. Sinaiko and Richard J. Zeckhauser
25. Presumed Consent to Organ Donation
David Orentlicher
List of Contributors
Index

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Author Bios
Featured Contributor

I. Glenn Cohen, JD

I. Glenn Cohen is a professor of law at Harvard Law School and the faculty director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics. He is the author of Patients with Passports: Medical Tourism, Law, and Ethics.
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Featured Contributor

Holly Fernandez Lynch JD, MBE

Holly Fernandez Lynch is the executive director of the Petrie-Flom Center. She is the author of Conflicts of Conscience in Health Care: An Institutional Compromise.
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Featured Contributor

Christopher T. Robertson JD

Christopher T. Robertson is a professor of law and the associate dean for research and innovation at the University of Arizona’s James E. Rogers College of Law. He is the coeditor of Blinding as a Solution to Bias: A Multidisciplinary Approach.
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