Fluent Essays

In this journal, you will be presented with a case study that you will use to study the impact of behavioral economics in healthcare.For additional details, review the Module Four Journal Guidelines and Rubric document. hcm_320_module_four_journal_guidelines_and_rubric.pdf the_case_for_incentivising_health_using_behavioural_economics_to_improve_health_and_wellness.pdf Unformatted Attachment Preview HCM 320 Module Four Journal Guidelines and Rubric The Case for Incentivising Health is based on Australian data, but the challenges of combating chronic disease there are similar to the challenges present in the United States. Read the case carefully and consider the list of main considerations those working in the preventative health space could think about when developing programs, policies or interventions to change behaviors listed on page five. Address the following questions:    Which of these cues do you consider to have the most impact in terms of changing healthcare behaviors of the patient? Which of these cues would you most readily respond to as a patient? Which cues do you think are most likely to be adopted by providers and insurance companies? Support your responses with examples from your own experience, the case, or references to the textbook or other scholarly sources. Use the journal as an opportunity to familiarize yourself with the final project requirements and case study. Journal activities in this course are private between you and your instructor. Only the instructor can view and comment on your assignments. Rubric Guidelines for Submission: Your journal assignment should be 2 to 4 paragraphs in length. Submit assignment as a Word document with double spacing, 12point Times New Roman font, and one-inch margins. Critical Elements Impact of Behavioral Cue Patient Response Providers and Insurance Companies Proficient (100\%) Discusses the impact of a behavioral cue in terms of changing healthcare behaviors and supports the discussion with examples or references Describes why a behavioral cue would produce positive responses from patients and supports the description with examples or references Identifies the behavioral cues that are most likely to be adopted by providers and insurance companies and supports the response with examples or references Needs Improvement (75\%) Discusses the impact of a behavioral cue in terms of changing healthcare behaviors, but does not support the discussion with examples or references Describes why a behavioral cue would produce positive responses from patients, but does not support the description with examples or references Identifies the behavioral cues that are most likely to be adopted by providers and insurance companies, but does not support the response with examples or references Not Evident (0\%) Does not discuss the impact of a behavioral cue in terms of changing healthcare behaviors Value 40 Does not describe why a behavioral cue would produce positive responses from patients 30 Does not identify the behavioral cues that are most likely to be adopted by providers and insurance companies 30 Total 100\% The Case for Incentivising Health Using behavioural economics to improve health and wellness A White Paper from AIA Australia Contents Contents Foreword  3 Executive summary  4 Introduction  6 Non-communicable diseases  8 Public health and health promotion  10 Behavioural economics and health  12 Wellness programs  20 Vitality case study  21 Conclusion  24 Bio of Professor Kevin Volpp, MD, PhD  25 Appendix A: The history of public health and health promotion  26 1 Foreword Foreword Two in three Australians are currently overweight or obese and chronic disease is the leading cause of death and disability in the country. These preventive health challenges affect all sectors in Australia, including the life insurance industry. At AIA Australia, we have seen this first hand, with increasing numbers of claims made because of chronic diseases that affect a person’s ability to work, causing financial strain and impacting on their quality of life. Finding a way to halt this trend is critical for Australians to live better and happier lives with their families and for a more sustainable future for our national health system. To help address this issue, AIA Australia is bringing the world’s largest health and wellness program – Vitality – to Australia. Using the latest research in behavioural economics and health incentives, Vitality is designed by academics and health practitioners to encourage people to take the first steps towards healthy living and, more importantly, to make these lifestyle changes permanent. AIA Vitality provides the knowledge and tools for people to achieve their health goals. Members of the program have the opportunity to complete full health and fitness assessments and earn points for undertaking healthy activities, such as buying healthy food and going to the gym. They are rewarded through discounts on shopping, entertainment and travel purchases, among other benefits. It will be sold initially through financial advisers to people who purchase an eligible life insurance policy with AIA Australia. Over five million people across five countries – South Africa, UK, USA, China and Singapore – are being motivated every day to lead healthier lives through Vitality, an incentive-based program. Evidence for the efficacy of the program – in terms of improved clinical outcomes, reduced healthcare costs, lower hospital admissions, increased productivity at work and improved mortality rates – has been profiled in leading academic journals such as the American Journal of Health Promotion. We believe that Vitality can have a very significant impact on Australia’s health, while at the same time revolutionising the life insurance industry. Research into the benefits of employing behavioural economics, such as through incentives and ‘nudges’, as a part of the array of health promotion tools is still in its infancy in Australia. However, there is rapidly growing interest by governments and NGOs in learning how to incorporate these principles into program planning and policy making. To help further this discussion, AIA Australia has commissioned this White Paper report titled The Case for Incentivising Health. Specifically, I’d like to thank Professor Kevin Volpp from the University of Pennsylvania for writing the introduction to the White Paper. Professor Volpp’s considerable guidance in sourcing the latest research in the area of health incentives has been invaluable and I’m delighted with our collaboration on this project. The White Paper aims to provide the latest research on how incentives and their associated principles can work to nudge people towards adopting and sustaining healthier behaviours. It is our hope that it can be used as an information and discussion resource by governments, NGOs and policy designers for when and how health incentives can work most effectively. PETER CREWE, CEO, AIA Australia 3 Executive summary Executive summary • This is a White Paper prepared by AIA Australia to discuss a new approach of using insights from behavioural economics and health incentives to develop new interventions and solutions to change health behaviours in the hope of eventually reducing the burden of non-communicable disease (NCDs). • The burden of NCDs is one of the greatest health challenges of the 21st century and one of the most significant economic challenges to both developed and developing countries. NCDs are the leading causes of death in most countries and account for 63\% of global mortality. In Australia 90\% of deaths are caused by NCDs. • NCD incidence is not only increasing, but also increasing rapidly with, for instance, Australia experiencing a 47\% increase in obesity between 1995 and 2012. • The overall cost to the health care system associated with the three most common contributors to NCDs – obesity, smoking and harmful drinking – is in the order of almost $6 billion dollars per year. • Our health is affected by a range of factors: significantly where we are born, grow up, live, work and age; but also, our decisions to adopt certain behaviours both healthy and otherwise. • Public health and health promotion have addressed health problems with a range of policies in regard to, for example, sewerage and clean air as well as society-wide approaches to reducing disadvantage through education, job creation and individual support together with health promotion campaigns. • In recent decades, insights from developing research in behavioural economics and psychology are driving new approaches to how individuals make decisions. • While standard economics has focused on ‘rational’ decision-making in which individuals seek to maximise what economists call their utility, behavioural economics has demonstrated that decision-making is often ‘predictably irrational’. 4 This irrationality stems from factors such as loss aversion (putting greater weight on losses than gains); status quo bias (taking the path of least resistance to continue what people are doing); the impact of framing (the way the frame of reference within which decisions are presented influence choices); present bias (focusing on immediate costs and benefit and undervaluing the future); and overweighting small probabilities (dreaming of winning the lottery without appreciating the real odds). • These insights have been applied to ‘nudge’ approaches to health promotion and, increasingly, the use of financial incentives to change behaviour. Examples of incentives to moderate bad health choices include incentives to reduce smoking among employees or pregnant women. Equally, they have been applied to other health problems such as medication non-adherence. These incentive approaches are most effective with frequent feedback and when the incentives are small, frequently provided and given soon after the activity has been completed. • Other behavioural economics insights have also been applied to motivate health and other choices through default policies (opt in versus opt out) and contractual and commitment pledges. Altruism and the human desire for approval have been used in situations ranging from mentoring for diabetes control in the US to condom distribution in Zambia. • A significant case study encompassing the behavioural economics principles and evidencebased applications is the wellness program, Vitality, which is being implemented in South Africa, the US, UK, China, Singapore and, shortly, in Australia. • Behavioural economics is a rapidly-emerging discipline with wide-ranging ramifications for not only health policy and practice, but also other areas such as finance and consumer policy. Increasingly its lessons, often combined with new technologies, will have significant impacts on health, health spending and costs and community well-being. Executive summary Drawing from behavioural economics insights, this report summarises the main considerations those working in the preventive health space could think about when developing programs, policies or interventions to change behaviours: • Provide small and frequent incentives close to the completion of a healthy activity to encourage adoption of healthy behaviours, while incorporating frequent feedback through the program (see page 14). • Consider the use of a lottery-draw to distribute incentives (see page 16). • Create an incentives structure that has attainable thresholds and with tiers of rewards so that a larger number of people are engaged (see page 20). • Encourage high frequency of participation in the healthy behaviour during the period when incentives are provided, to improve the potential that the behaviour will be sustained when the incentives are removed (see page 15). • Consider the importance of testing different types of messaging, as the same information conveyed in different ways can have extremely different effects (see page 13). • Consider the use of ‘contracts’ and commitment devices to pledge to a certain behaviour or goal (see page 17). • Make the healthier option the default or “path of least resistance” option, making it easier for the individual to choose, adopt and sustain that healthier behaviour rather than the unhealthy option (see page 17). • Consider the use of modern technology such as mobile apps and social media to monitor health behaviour and outcomes outside of the GP clinic or hospital (see page 19). • Leverage social altruism through programs such as offering people who have excelled in mastering a particular disease the opportunity to provide peer support to others who might benefit from such assistance (see page 18). • Incorporate social recognition aspects into program design (see page 18). This paper is provided for your general information only and is not in any way intended to be medical, nutritional, health, fitness or other advice or to act as a substitute for such advice or to influence you to acquire any products or services. The information in this paper does not take into account your personal circumstances and is subject to change. You should obtain professional advice from a medical practitioner, pharmacist, dentist, nutritionist or other appropriate health professional in relation to your own personal circumstances or in relation to the diagnosis or treatment of any medical condition. If necessary, you should regularly consult with such a professional. 5 Introduction Introduction By Kevin G. Volpp, MD, PhD Professor of Medicine, Perelman School of Medicine; Professor of Health Care Management, the Wharton School; Director, Center for Health Incentives and Behavioral Economics, Leonard Davis Institute, all of the University of Pennsylvania USA; Principal, ValHealth. It has become increasingly clear that health behaviours contribute significantly to poor health outcomes and increased health costs. Harmful behaviours are observed as factors in contexts ranging from cardiovascular disease morbidity and mortality owing to poor medication adherence, to the widely acknowledged harms from smoking and obesity. While societal factors and structures, genes and the environment play a large role in contributing to these conditions, behaviour choices impact both the incidence and the trajectory of these conditions. This provides hope that the health harms from smoking, obesity, and low rates of engagement in areas such as medication non-adherence can be ameliorated or reversed. In recent years, there have been dramatic advances in the science of behavioural economics. Behavioural economics utilises insights from psychology to enhance standard economic models of behaviour, which presume people are perfectly ‘rational’. Extensive academic work has shown that people are often irrational, but that this follows patterns that are well enough understood to both make clear how such behavioural biases contribute to unhealthy behaviour and provide guidance on how interventions can be structured to improve health behaviour. 6 This White Paper describes some of the key areas in which behavioural economics has made contributions, such as: present-biased preferences (the tendency to focus on the immediate costs and benefits of an action); loss aversion (which makes people more motivated by a desire to avoid losses than to obtain gains); the default or status quo bias (which encourages the ‘path of least resistance’); framing (in which people respond very differently to alternatives, depending on how they are described); and nonlinear probability weighting, specifically the overweighting of small probabilities near zero (the inaccurate assessment of lottery odds, for example). It then discusses some of the key studies that have begun to shape our collective understanding of how incentives that leverage some of the above behavioural economic principles have been used in practice to modify health behaviours in a variety of contexts and contrasts these with the standard economic approach. Incentive programs to date have shown much progress in addressing these problems and are discussed in some detail, and through case studies, in this paper. Efforts are now ongoing to continue to improve the contributions of behavioural economics to health in areas such as improving Introduction habit formation, better utilising pro-social motivation and using wireless technologies for chronic disease management. This will continue to be an exciting area for years to come as countries see increasing demand for achieving higher value and improvements in health, in return for growing spending in health across all industrialised countries. This need is being exacerbated by a climate in which both public and private sectors face budgetary pressures. Healthcare financing has typically focused primarily on the treatment of diseases and in providing fee-for-service healthcare services within the four walls of a doctor’s office. However, there is growing recognition in the US that paying for health services on a fee-for-service basis typically leads to a high rate of service provision, but not necessarily of keeping people healthy. While the Australian healthcare system is significantly different, some of the same issues apply in terms of use of GPs and the acute and sub-acute system. Significant new efforts are underway in a number of countries to shift healthcare financing to focus more on keeping people healthy as opposed to treating them once they get sick. This will drive demand for more effective and efficient solutions to chronic disease management and keeping populations of people healthy. A significant development in this area has been the use, and study of, the effectiveness of incentives to achieve these goals. For example, about 85\% of large employers in the United States used incentives to motivate healthy behaviour this year in recognition of the role that unhealthy behaviour plays in contributing to high health costs and poor outcomes. In the UK, a pilot scheme is being conducted in the disadvantaged areas of South Yorkshire and Derbyshire to see the impact of offering new mothers up to £200 in shopping vouchers to encourage them to breastfeed their babies. There is also recognition of the need to align individual incentives towards working to improve health. In Australia, there is a community-wide incentive system to encourage participation in health insurance through the Lifetime Health Cover program, which encourages people to take out health insurance when young. If taking out health insurance is deferred to later ages, a loading calculated on the basis of that age is imposed on health insurance programs. This acts to moderate health insurance rates for all Australians by shifting the actuarial risk in the total health insurance pool. While this program does not appear to have been analysed within a behavioural economics framework, it was an early Australian example of using a mix of incentives and disincentives to address health costs. Vitality has been a leader among commercial programs in using behavioural economic principles to influence health behaviour for about two decades within South Africa and, in more recent years, within the US, through a joint venture with Humana, and in the UK, through PruHealth. The AIA Vitality joint venture represents an innovative foray into this arena within Australia. It will provide further evidence-based solutions on the impact of incentives on health; how to improve services that complement healthcare delivery; and how insurance plan designs can contribute to the goals. 7 Non-communicable diseases Non-communicable diseases The burden of non-communicable diseases It is evident that one of the greatest health challenges of the 21st century, and one of the greatest economic challenges to date, is that of non-communicable diseases (NCDs). These largely preventable lifestyle-associated conditions, driven by unhealthy behaviours and other environmental and socioeconomic factors, are the leading causes of death in most countries and account for 63\% of global mortality.1 In Australia, 90\% of deaths are caused by NCDs.2 According to the World Health Organization, the principal global risk f ... Purchase answer to see full attachment