Tailored financial incentives to fight medical non-persistence in therapeutic treatment: a behavioral economic engineering approach

The development and design of financial incentiveschemes as a sustainable and cost-effectiveintervention strategy to foster effectiveness ofmedical interventions remains a significantchallenge in health care delivery.Based on the findings of the conceptual model ofmedical non-persistence we test three differentfinancial incentive schemes. These incentives arederived upon concepts of behavioral economics, inparticular mental accounting, prospect theory andchoice bracketing, and incorporated into deposit,copayment and bonus schemes. We conductrandomized laboratory experiments to evaluate theperformance and effectiveness of each incentivescheme on persistence behavior under controlledconditions. Participants in the experiment arestudents remunerated according to theirperformance in the experiment.We find that financial incentive schemes based onthe principles of prospect theory significantlyimprove treatment persistence compared to thesituation where there are no incentives at all. Thisfinding implies that the simple but smart reallocationof co-payments and co-payment supportbetween the treatment initiation phase and treatmentmaintenance phase represents an effective way ofpromoting persistence behavior.This study delivers first applications of behavioralinterventions based on theoretical foundation. Usingthe method of experimental economics the studyserves as a first proof of concept of a scalable wayto design, calibrate and test the effectiveness offinancial incentives on behavioral change. Thisapproach is inevitable for broad application in realworld as it minimizes the need for patient researchwhile clarifying the impact of interventions undercontrolled conditions before these interventions getimplemented in the field. ; eng