India today poses a drastically different picture than it a few decades ago. It has a burgeoning middle class, which has begun to spend increasingly on fast food meals and luxury goods. This has given rise to a gamut of health issues, which, coupled with the quickening penetration of the health insurance sector, has resulted in a population that frequently needs to seek out healthcare services, and only from premiere hospitals.
Another trend of relevance is the explosion of private medical institutes across the country, with dubious capabilities to teach medical theory and surgery. Such institutes offer to accommodate a larger number of students than their government counterparts, often at a higher fee, with the guarantee of a bachelor’s or master’s degree in staple amount of years. While there is a competent authority that oversees the quality and control of such institutes (the Medical Council of India), the fact of the matter remains that the students simply do not meet the high standards of government-college-educated physicians. The effect is lagged; the trend of private institutes began in the mid-1990s, subsequently, the physicians that hold their degrees are still in the early-to-mid career stage, and may not yet be in possession of independent hospitals or high ranks in major hospitals.
Given the high demand for healthcare that the country faces, and the seemingly inadequate pedagogy, to cater to the changing system, the time for a shift in mentality has come. We are in the midst of a third Industrial Revolution, and it can be guaranteed that a new, unknown host of ailments will appear, as diseases evolve along with societies. The role of healthcare is not limited to the doctor’s premises any longer. The idea that a disease and its repercussions are curtailed by a mere prescription, thereby ending the role of the doctor in the transaction is a redundant approach.
This is where healthcare can borrow ideas from behavioural economics. The central tenet of behavioural economics is that human beings are not rational, omniscient beings. They are impulsive and short sighted. They weigh short term gains higher than long term gains, and are often prone to taking decisions that are not in their best interest. These insights translate into patient biases and doctor biases, which have been documented by Chapman et al (2013).
The application of behavioural insights can be broadly classified as patient-targeting and doctor-targeting. In respect to the former, the ubiquity of technology is an opportunity that can be used in favour of the cause. A recent study by Adamson et al (2016) showed that patients were more likely to fill out their prescriptions if they were in the electronic format rather than the paper format in the long run, because of the ease and convenience of having everything in one place, and not having going through the hassle of placing the paper safely. Further, if the prescription exceeded three in number, the likelihood of misplacement rose. The fringe benefit of the method was a vast reduction in prescription errors. In a similar study by Fenerty et al (2012), timed reminders to patients to fill out prescriptions and adhere to the schedule of intake proved to increase patient adherence by 66%.
Another application can be of a feedback mechanism that notifies the patient of consequences of a certain action, in order for her to curb harmful behaviour. A study by Parkes et al (2008), found that when smokers were informed of the age of their lungs, 13.6% of them showed signs of quitting completely. This study is useful to treat patients with behaviour patterns that can be corrected, such as eating disorders.
There is scope for doctor-targeting interventions as well. A recent study by Meeker, Linder and Fox (2016), found out that physicians were less likely to overprescribe antibiotics when one of the three interventions were enforced: a prompt that suggested non-antibiotic prescriptions, asking the physician to justify the prescription through text inputs, and peer comparisons that compared prescription rates with those of ‘top performers’, i.e., the ones with the lowest antibiotic prescription rates. Another study by Asch et al (2015) financially incentivised both physicians and coronary artery disease patients to achieve low levels of cholesterol levels, and found significant reductions in mean levels.
Behavioural interventions capitalise on the irrationality of the human mind, but few take into account its heuristic nature. There is little proof that the changed behaviour is for the long term. Additionally, some interventions, especially the ones that require financial incentives, are unsustainable from the viewpoint of the administrator. The benefits accrued from the interventions – good health, less risk of disease – cannot be rationally compared and proven to be overshadowing the costs.
There is tremendous scope for further study in this intersectional field. Economists like Amy Finkelstein, Janet Currie, Angus Deaton etc have laid the groundwork for future study. A special focus must be given to India by its domestic economists as it is diverse in terms of income, access, preferences, genetics, and many other factors. Policies and insurances that are specifically catered for the Indian market will go a long way in public health measures.
Aishwarya Deshpande
