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General interest items edited by Janice Flahiff

[Reblog] Eight Bright New Ideas From Behavioral Economists That Could Help You Get Healthy

Not sure if this is the right approach. I was brought unto be personally responsible for my actions and not rely on others to create ways to help me do the right things.  Part of my thinks money spent on these grants could be better spent elsewhere. These ideas seem to be only shotgun approaches and do not really address underlying issues.

Still, I think their hearts are in the right place.

 

By DEBORAH BAE at the 6 December 2013 posting at The Health Care Blog

Through a series of small grants, we’re is exploring the utility of applying behavioral economic principles to perplexing health and health care problems—everything from getting seniors to walk more to forgoing low-value health care.

At a recent meeting in Philadelphia we challenged grantees to compete in an Innovation Tournament. The goal was to identify testable ideas that leverage behavioral economic principles to help make people healthier by working with commercial entities. Participants were assigned to groups and made their best pitches to their colleagues. And of course we used a behavioral economics principle (financial incentives) to increase participation: Each member of the first, second and third place teams received Amazon gift cards.

Eight teams made the finals:

1.     Love Lock: This team addressed the issue of driving and texting by proposing an app that could be installed on your cell phone that would send reminders not to text while driving. This team would work with car insurance and mobile phone carrier companies and provide discounts to those who get it installed. The behavioral economics principles being tested are default choice and opt-out.

2.     McQuick & Fit: Too many people eat unhealthy food. This team’s idea was to have a rewards card that can only be used to purchase healthy food. With each purchase, the customer would earn points toward free, healthy foods. Online orders would be placed through a website that would feature salient labeling and allow for defaults to order healthy meals. The behavioral economics principles at play include pre-commitment, default choice, labeling, and incentives.

3.     Just Bring Me Water: The problem tackled by this team is “regrettable” calories—mindlessly consuming whatever is put in front of you, such as free bread at a restaurant, or soda on a plane. The innovation: when booking a table online or calling for a reservation, you could ask to “opt-out” of the complimentary bread or chips that are offered. This would reduce the consumption of regrettable calories.

4.     Lunch Club: This group looked at addressing gluttony through a partnership with a chain restaurant. When going out for a meal, portions are typically bigger and diners consume more. But what if you had the option of doggy-bagging one third of the meal for another meal—framed as “buy dinner and get lunch free”? And, if you took this option, you would get a scratch off as an enhanced incentive and immediate reward. The behavioral economic principles being tested here include loss aversion, active choice, and incentives.

5.     Snooze, But Don’t Lose: People don’t get enough good sleep, which leads to poor executive functioning and safety issues. To increase safety, productivity, and efficiency, this group proposed using a Fitbit to build in reminders to go to bed earlier and provide feedback on good sleep. The behavioral economic principles at play are pre-commitment and loss aversion.

 

6.     Google Coach: This team’s idea was to create good habit formation, specifically commitment to a health plan, whether it was getting more sleep, adhering to a diet, or taking vitamins regularly. The group proposed partnering with Google and using its calendar and mobile phone platform to program smart defaults that are personalized to the individual. For example, people could actively schedule exercise or sleep based on their schedule on Google calendar. The group hypothesized that intelligent defaults are better than people planning themselves (without defaults).

7.     The Basketeers: This team wanted to optimize consumers’ baskets at grocery stores and supermarkets, increasing the amount of healthy items purchased. The group suggested partnering with an online supermarket to create different packages of food for customers to purchase. For example, there could be the J-Lo package, which would bundle together food items that this aspirational star would most likely eat. In addition, when checking out, the website would assess the customer’s basket for healthier options, such as switching whole milk for skim milk. As a reward, consumers would get discounts and express delivery for choosing healthier options.

8.     Team REV (Re-Engineering Vending): Soda and other sugar sweetened beverages lead to obesity. This team proposed partnering with beverage companies to make vending machines more fun, while optimizing them to help people make healthier beverage selections. For instance, the vending machine would have sensors and as you approach the unhealthy items, the healthier item buttons would light up. The behavioral economics principle applied here is choice architecture.

The participants voted for their top three choices. Lunch Club came in third while Love Lock and Google Coach tied for first place. And, you might wonder, how does a group of behavioral economists and psychologists break a tie? By playing rock, paper, scissors. Team Love Lock won.

This post originally appeared in the RWJF Pioneering Ideas Blog.

 

 

December 6, 2013 Posted by | Nutrition, Public Health | , | Leave a comment

[Reblog] Is There Really a Physician Shortage?

By  DAVID AUERBACH in the 5 December 2013 posting at The Health Care Blog

Large coverage expansions under the Affordable Care Act have reignited concerns about physician shortages. The Association of American Medical Colleges (AAMC) continues to forecast large shortfalls (130,000 by 2025) and has pushed for additional Medicare funding of residency slots as a key solution.

These shortage estimates result from models that forecast future supply of, and demand for, physicians – largely based on past trends and current practice. While useful exercises, they do not necessarily imply that intervening to boost physician supply would be worth the investment. Here are a few reasons why.

1. Most physician shortage forecast modelsassume insurance coverage expansions under the ACA will generate large increases in demand for physiciansThe standard underlying assumption is that each newly insured individual will roughly double their demand for care upon becoming insured (based on the observation that the uninsured currently use about half as much care). However, the best studies of this – those using randomized trials or observed behavior following health insurance changes – tend to find increases closer to one-third rather than a doubling.

2. A recent article in Health Affairs found that the growing use of telehealth technologies, such as virtual office visits and diagnoses, could reduce demand for physicians by 25% or more.

3. New models of care, such as the patient-centered medical home and the nurse-managed health center, appear to provide equally effective primary care but with fewer physicians. If these models, fostered by the ACA, continue to grow, they could reduce predicted physician shortages by half.
4. New research has shown that physicians do an enormous amount of work that can be handled competently by medical assistants, licensed practical nurses, social workers, pharmacists and others. Proper delegation to other health care professionals and non-professionals in this way can further reduce the need for physician labor and increase the efficiency of health care services — though providers will have to pursue these changes to the see the benefits.

5. Finally, the number of active physicians per-capitavaries by more than a factor of two across states in the US (Massachusetts has more than double the physicians per capita as Idaho) and even more across smaller regions. Though health care quality and access surely suffers in some areas, there is little correlation with physician supply overall – a testament to the fact that there is a very wide range of physician supply capable of supporting successful health care.

As modeling technology continues to evolve and the effects of ACA implementation become clearer, new models should be able to account for physicians’ shifting responsibilities and new ways of practicing. It is also certainly possible that new care models will place additional demands on physicians to manage their patients’ conditions and coordinate their care. Nevertheless, on the whole, the latest research suggests that calls to redirect taxpayer dollars to subsidize physician residencies may be premature.

David Auerbach is a policy researcher at the nonprofit, nonpartisan RAND Corporation.

 

 

December 6, 2013 Posted by | health care | , , | Leave a comment

   

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