Financial Group Incentives Improving Medication Persistence - Health Behavior Engineering Approach

Abstract

In the current study we develop and evaluate different group-based financial incentives based on the concept of loss aversion and social effects. Behavioral engineering approaches have been demonstrated to be key in improving persistence behavior which continues to be a primary target of efforts to improve health outcomes for patients with chronic disease. However, there is limited research trying to successfully design and calibrate group-based incentives in anonymous settings as a sustainable and cost-effective intervention strategy. The current study follows the procedure of behavioral economic engineering. Based on the findings of the conceptual model of medical non-persistence we engineer two different group-based financial incentive schemes which are predicted to increase persistence. These incentives are derived upon concepts of behavioral economics, in particular social effects, guilt aversion and peer competition, and incorporated into tailored group-contingent bonus schemes. We conduct randomized behavioral laboratory experiments to evaluate the performance and effectiveness of each incentive scheme under controlled conditions. Implementing group-contingent bonus schemes in an anonymous setting significantly improve treatment persistence compared to control. Group impact, guilt aversion and peer competition seem to each influence individual behavior to continue with therapy. Previous research demonstrated that individual financial incentive schemes build on principles of behavioral economics, and thus the personally expected consequences, drive treatment persistence. Peer competition is a key underlying mechanism of gamification approaches. The current study shows that peer competition in the context of financial incentives is a vital mechanism to promote individual persistence behavior. Further on, the findings suggest that patients take expected impact on others into account as well. These results do not only seem to be surprising as the impact of peer effects and guilt aversion in anonymous settings is quite often neglected, but open up new opportunities for the design and calibration of consumer/health behavior incentives.