Eric Finkelstein of the the Duke Graduate Medical School in Singapore studies how economic principles might be used to improve individual healthcare.
At a talk last Friday, Finkelstein, who was selected by Thomson Reuters as one of the world’s most influential scientific minds of 2015, argued that the same biases that affect our economic decisions could also influence our healthcare choices, and that understanding these biases could help motivate individuals to live healthy active lives.
In theory, people should be able to make healthy choices, Finkelstein said. Under the utility maximization model, individuals have the ability to rationalize and recognize the benefits of taking particular actions for themselves. But often we are not rational beings, he said, and there are several “deviations” that steer us away from maximizing our utility.
One of these deviations is the “present bias” preference, which leads us to make decisions in the present that our future self will regret. He discussed a particular experiment in which people are asked to choose what they will eat in one week’s time: a candy bar or an apple. Most choose the apple, but after a week, when they were given the opportunity to reevaluate their choice and change it, most switch to the candy bar.
This experiment shows not only the dynamic, unpredictable nature of our decisions, but also highlights our tendency to overestimate the will power of our “future selves.”
Another interesting bias that prevents us from being rational is our probabilistic assessment bias, which describes our tendency to overestimate the probability of very unlikely events, while underestimating the probability of those that are likely. This bias directly relates to health and our tendency to ignore the possibility of suffering a detrimental health problem like a heart attack, when in reality it’s quite commonplace.
To understand how these biases might influence individuals suddenly diagnosed with a terminal illness, Finkelstein and his medical team in Singapore conducted their own study on healthcare choices. In the experiment, both healthy and sick individuals were asked to identify what treatments they would prioritize if diagnosed with terminal cancer: level of pain, hours of care required, potential to extend life, cost of treatment and location of death.
Most healthy individuals said they would want whatever treatment was cheapest, but showed very little interest in investing in extending their life or selecting where they died. When sick patients were asked the same questions, on the other hand, they valued place of death (home was preferred) and survival time above everything else. Such information indicates just how difficult it is for us to predict where to invest in healthcare for cancer patients.
From this study and several others, Finkelstein concludes that we are not rational beings, but are instead irrational ones that feed off of biases and change our opinions constantly. But, he suggests that through the use of incentives, we can mediate these irrational biases and ultimately improve health outcomes.
Post by Lola Sanchez-Carrion