Choice Architecture and Simplifying: Alternatives to Incentives for Increasing Healthy Behaviors.

Abstract

This issue’s article “Medicaid and CHIP Child Health Beneficiary Incentives: Program Landscape and Stakeholder Insights” by Moseley et al1 nicely summarized the characteristics of 82 initiatives designed to improve the health of publicly insured children. More importantly, these authors provided a well-balanced perspective on the strengths and limitations of the incentives. Such beneficiary incentive programs have a compelling rationale. These incentives are directed toward lower-income families who may be highly motivated to save money and/or obtain much-needed tangible assistance. In addition, incentives may signal to families the importance of particular health behaviors. Furthermore, short-run incentives may have lasting effects because some target behaviors either confer long-term health benefits or become more habitual. Despite their intuitive appeal, beneficiary incentive programs may not produce intended benefits. There is slim empirical evidence supporting the use of such incentives for the distal pediatric outcomes of decreasing morbidity, mortality, or health care expenditures. Moseley et al1 did cite some studies demonstrating that incentives increased proximal health behaviors for youth, such as well-child visits.2–7 However, most incentive programs lack published and/or conclusive … Address correspondence to Jack Stevens, PhD, Nationwide Children’s Hospital, The Ohio State University of Pediatrics, Faculty Office Building 3rd Floor, Columbus, OH 43205. E-mail: jack.stevens{at}nationwidechildrens.org