Magazine article Policy & Practice

Using Behavioral Economics to Move the Needle on Maternal and Child Health

Magazine article Policy & Practice

Using Behavioral Economics to Move the Needle on Maternal and Child Health

Article excerpt

Have you ever sworn off fast food, only to sneak a fry from your kid's plate when she looks the other way? Or realized you still haven't enrolled in that 401k plan even though you promised yourself you would? Sure you have. We all have.

As common as these problems are, they're pretty odd when you think about it. We tend to see ourselves as rational human beings who make decisions consistent with our own self-interests, but these are just two examples of how we make choices each day that are at odds with what we actually want for ourselves.

It turns out that economists can't always predict how even the most rational people will respond to policies or incentives. So how can policymakers design programs to drive desired behaviors?

That might be a job for behavioral economists. Behavioral economics goes beyond simple incentive structures and examines the complex psychological, social, and cognitive factors that affect human decision-making. Through an understanding of these factors, behavioral economists develop theories about human behavior, run real-world experiments to validate their hypotheses, and offer solutions.

Governments use of behavioral economics is fairly recent. In 2010, Britain became the first country to create a government unit dedicated to the study and application of behavioral economics. The Behavioural Insights Team (BIT), also known as the "Nudge Unit," designs interventions that prompt people to pay their taxes on time, or show up for scheduled medical appointments. (1)

Indeed, the field of behavioral economics is ripe with applications for health care, and the Medicaid program in particular. Medicaid accounts for a substantial portion of state budgets and covers vulnerable populations at critical points in their lives. And though Medicaid coverage and services are available at nominal or no-cost, getting eligible people to enroll in the program and use cost-effective preventive services can be a challenge. (2) Behavioral economics can offer a low-cost way to decrease program costs while driving better health outcomes--a true "win-win" strategy.

Focus the Microscope: Drawing from Behavioral Science to Promote Maternal and Child Health

Collectively, Medicaid programs across the country cover roughly half of all childbirths and 40 percent of children. (3,4) This makes the program uniquely positioned to promote maternal and child health in the United States. In our recent report, Mindful Medicaid, we discuss how pregnant women enrolled in Medicaid are more likely than women with private insurance to delay prenatal care until late in their pregnancy or to skip prenatal care altogether, and how low-income children are less likely than higher income children to receive complete vaccinations. (5)

To address these disparities, we explore how behavioral economics could be harnessed to move the needle on maternal and child health in Medicaid by focusing on three areas:

1) Messaging. Communications that leverage positive peer pressure (or social proof, as behavioral economists like to call it) can be effective at getting pregnant women to quit smoking. The Louisiana Department of Health has already caught on to this concept. It has teamed up with the 2Morrow Inc. smoking cessation app, SmartQuit, which regularly sends soon-to-be parents success stories about people who, under similar pressures, were able to quit smoking to achieve their goals. Though it is still early, the initial results have suggested that the behavioral-based strategies of SmartQuit are more effective than alternative smoking cessation apps. (6)

2) Choice architecture. Behavioral science reveals that people are more likely to stick with a default--the result you get if you do not make a choice--than they are to actively make a new, alternative choice. So why not make the default the best option? There is evidence that automatically booking people for vaccination appointments increases vaccination rates. …

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