Behavioural economics and integrated care

In 2012, Kahneman united Smith’s two views in one readable book titled Thinking Slow and Fast.Kahneman, who won the Nobel Prize in 2002, distinguishes two systems used by the brain to form thoughts. System 1 thinks fast, in stereotypes and emotions. This system works unconsciously. Nowadays, this system is referred to as intuition. System 2, in other words the rational mind, is slow, calculates logically and works consciously. Pushing and nudging the consumer into the direction of rational, long-term thought according to Kahneman’s system 2 is called libertarian paternalism. This term is discussed at length by Rice, who published an overview article about the use of behavioural economics in healthcare.4 Behavioural economics is the science of the effects of knowledge and of social and emotional factors on economic decisions and the use of resources, costs and revenue. Important concepts are Nudging and Framing. A nudge is a small financial, or other, change in the supply of goods or services that significantly changes the behaviour of consumers. Framing is a technique of persuasion that uses words and images to implicitly accentuate certain aspects of a person or object and thereby influence a decision. The creator of the term nudging,Richard Thaler received in 2017 the Nobel Prize.  In this proposed  presentation I will give the theory, background and application of behavorial in integrated care experiments. Five  imitatives are discussed:  1- Traditionally, Dutch parents who bring their children to the dentist for a semi-annual check-up do not have to pay for dental treatment if oral health problems occur in the meantime.. Without this check-up, parents do have to pay for the treatment.  2- A more modern example is a German nudge aimed at people with a chronic condition.Subscribed patients with a chronic condition subscribe to a disease management programme. In doing so they commit themselves to participating at least once a year in a course about their condition and how to deal with it. Subscribed members are exempted from paying individual contributions for primary healthcare use.  3- A third example is the South African Vitality Health Promotion Programme. It uses financial incentives and cooperates with supermarkets, gyms and health insurance companies. The Vitality programme is successful in achieving its goals: increasing participants’ health and lowering their costs of care.  4- A similar option is provided by the American Affordable Care Act. This law makes it possible to offer insurants who live healthy lives do not smoke and/or have a healthy body weight an insurance premium discount of 30 percent or even 50 percent in special cases.  5- Some Accountable Care organizations working with population based on integrated primary ena hospital care realize a reduction in cost growth. One these has the name of Alternative Quality Contract. The lecture is based on: 1- Kahneman D., Thinking, Fast and Slow, Penguin Books Ltd, 2012. 2- Thaler R.H. & C.R. Sunstein, Nudge. Improving decisions about health, health and happiness, New York: Penguin Books, 2009 revised and expanded edition. 3- Refrences on the initiative are gviven during the presentation.