Wanted: Nudges for helping people take their medicines
In a fascinating piece for Slate, Jessica Wapner highlights a great example of a self-control problem: Failing to take your medicine (In the medical community this is known as patient non-compliance).
Overall, about half of us fail to correctly follow our doctors’ directions for prescriptions. Wapner gives examples of three interesting technological nudges for helping patients take their pills.
1) A necklace developed by Georgia Tech scientists that records the date and time when a patient swallows a pill, and reminds her (and her doctor) when a dose is missed.
2) A prosthetic tooth that releases medicine into a patient’s mouth.
Non-compliance is not a behavior that only affects the patient. It affects the rest of us through unnecessary medical costs and lost revenue that could be as high as $177 billion annually in the U.S. Technological nudges are welcomed, but reducing noncompliance will probably require 1) more research into who the non-compliers are and why the fail to follow their doctors’ orders, and 2) health policy that deals more comprehensively with non-compliance problems.
For example, Congress is considering a bill that would tie Medicare payments to physicians’ use of e-Prescription technology that tends to increase generic use and formulary compliance, thereby decreasing overall costs. Similar policy specifications may be worth considering for products or procedures that increase patient compliance.
There is evidence that the amount of money patients pay for doctors visits and pharmaceuticals affects the frequency with which they take medication properly. Higher doctor visit fees can raise barriers to compliance (patients may not pick up a needed medication or skip a dosage period), meaning co-payment designs are one policy tool for affecting health care behaviors.
David Nash, a medical professor at Jefferson College, suggests that one option for governments and companies is the adoption of benefit-based co-payment designs. These systems have tiered co-payments where levels depend on the seriousness of the illness, where drugs required to treat chronic conditions and drugs that have strong records of effectiveness have lower co-payments. In some cases, this may even mean co-payments of $0.