Tag Archives: Behavioral Economics

Why are antibiotics over prescribed in some countries?

Antibiotic prescription rate differs across countries. It is two times greater in Korea than in Norway (27.9 vs. 15.8: Defined Daily Doses (DDDs) per 1000 people per day, 2015 OECD report). Why are antibiotics over prescribed in Korea?

One reason might be that it is difficult to find traditional medicines in Korean market. In contrast, Norwegians can buy a FLU SHOT at convenience stores. It is a bitter version of Jamba Juice. It is filled with traditional medicines such as ginger, turmeric, garlic, and cayenne pepper.

If I can buy the same FLU SHOT in Korea, I may not need to see doctors often. My thought provides fresh insights into behavioral economists. In the past, how to nudge doctors not to prescribe antibiotics was studied. Now, how to nudge patients not to see doctors may need to be studied.

Reference

Meeker, Daniella, Jeffrey A. Linder, Craig R. Fox, Mark W. Friedberg, Stephen D. Persell, Noah J. Goldstein, Tara K. Knight, Joel W. Hay, Jason N. Doctor (2016), “Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial,” Journal of the American Medical Association, 315 (6), 562-570.

IMPORTANCE: Interventions based on behavioral science might reduce inappropriate antibiotic prescribing.

OBJECTIVE: To assess effects of behavioral interventions and rates of inappropriate (not guideline-concordant) antibiotic prescribing during ambulatory visits for acute respiratory tract infections.

DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized clinical trial conducted among 47 primary care practices in Boston and Los Angeles. Participants were 248 enrolled clinicians randomized to receive 0, 1, 2, or 3 interventions for 18 months. All clinicians received education on antibiotic prescribing guidelines on enrollment. Interventions began between November 1, 2011, and October 1, 2012. Follow-up for the latest-starting sites ended on April 1, 2014. Adult patients with comorbidities and concomitant infections were excluded.

INTERVENTIONS: Three behavioral interventions, implemented alone or in combination: suggested alternatives presented electronic order sets suggesting nonantibiotic treatments; accountable justification prompted clinicians to enter free-text justifications for prescribing antibiotics into patients’ electronic health records; peer comparison sent emails to clinicians that compared their antibiotic prescribing rates with those of “top performers” (those with the lowest inappropriate prescribing rates).

MAIN OUTCOMES AND MEASURES: Antibiotic prescribing rates for visits with antibiotic-inappropriate diagnoses (nonspecific upper respiratory tract infections, acute bronchitis, and influenza) from 18 months preintervention to 18 months afterward, adjusting each intervention’s effects for co-occurring interventions and preintervention trends, with random effects for practices and clinicians.

RESULTS: There were 14,753 visits (mean patient age, 47 years; 69% women) for antibiotic-inappropriate acute respiratory tract infections during the baseline period and 16,959 visits (mean patient age, 48 years; 67% women) during the intervention period. Mean antibiotic prescribing rates decreased from 24.1% at intervention start to 13.1% at intervention month 18 (absolute difference, -11.0%) for control practices; from 22.1% to 6.1% (absolute difference, -16.0%) for suggested alternatives (difference in differences, -5.0% [95% CI, -7.8% to 0.1%]; P = .66 for differences in trajectories); from 23.2% to 5.2% (absolute difference, -18.1%) for accountable justification (difference in differences, -7.0% [95% CI, -9.1% to -2.9%]; P < .001); and from 19.9% to 3.7% (absolute difference, -16.3%) for peer comparison (difference in differences, -5.2% [95% CI, -6.9% to -1.6%]; P < .001). There were no statistically significant interactions (neither synergy nor interference) between interventions.

CONCLUSIONS AND RELEVANCE: Among primary care practices, the use of accountable justification and peer comparison as behavioral interventions resulted in lower rates of inappropriate antibiotic prescribing for acute respiratory tract infections.

People tip more when they disagree with a statement

Flam is a small village in Norway. Tourists who take the Norway in a Nutshell tours switch ferry boats here. A cozy restaurant called Bakkastova Cafe is located up on the hill.

 

 

This restaurant had a note at the cash register. It says, statistics say that women are tipping better than men. I added coins to the tip jar labeled men because I wanted to oppose this questionable argument. Others might tip if they support it.

 

 

This suggests that scientifically proven or well supported arguments may fail to motivate people to behave in a certain way. Rather, incomplete, controversial arguments trigger people’s willingness to speak out and may lead them to make an action. From the behavioral economics’ perspective, people’s avoidance for perfection seems to be a better nudge compared to either putting on some lipsticks to make something look like a human or painting foot prints on the street.

 

 

How to enjoy coffee more and consume plastics less?

Taipei is hot in summer. After sweating an hour, I ordered an iced coffee at 羊毛與花 Youmoutoohana Coffee. To my surprise, it served me a glass of coffee with a metal straw. After sipping coffee through it, I became a huge fan of metal straw. This summer, I will buy and bring a few metal straws to office with me to enjoy coffee more and consume plastics less.

 

 

Someone in US also found metal straw stylish and eco-friendly. Bethany Blakeman wrote in her blog,

 

I keep these in my tote bag (if you are worried about them getting dirty, I suggest a pencil pouch), and whip them up out whenever I’m at a coffee shop. Once at Starbucks, a talkative barista commented on my straw. “Hey, I’m with you,” he told me. “You’d hate to work here. You see how wasteful people are from behind this counter.” I’ll be gifting them to all of my friends for World Oceans Day on June 8.

 

 

People tip less when the tip jar looks like a human

Henckell is my favorite cafe in Frederiksberg, Copenhagen. It is a local place with great coffee and sandwich. I feel cozy inside. It has only four small tables.

There is a tip jar next to the credit card machine on the counter table. Interestingly, it has a smiley face, two arms, and two legs. One day out of curiosity, I kept watching how many guests tipped in this human-looking tip jar. Afterwards, I also asked a server whether guests liked it. Surprisingly, I noticed that a few guests hesitated putting coins into this jar for an unknown reason. The server even told me that not few guests complained about the tip jar because its mouth is too small to insert coins.

When human flavor is added to an object, people like the object. It is supported by academic studies about anthropomorphism. For instance, when a car is anthropomorphized and its characteristics are congruent with the proposed human schema, people evaluate it positively (Aggarwal and McGill 2007). When a garbage bin is anthropomorphized (e.g., “feed me”), people follow the message and show prosocial behaviors (Ahn, Kim, Aggarwal 2013). When an innovative, uncertain product is anthropomorphized (e.g., “this little guy”), people tend to adopt this product (Jiang, Hoegg, and Dahl 2011).

However, anthropomorphism might backfire if the usefulness of the product is sacrificed. When I come back to this cafe, I want to draw a different character with a bigger mouth and see what happens.

***

Reference

Ahn, H. K., Kim, H. J., & Aggarwal, P. (2014). Helping Fellow Beings: Anthropomorphized Social Causes and the Role of Anticipatory Guilt. Psychological Science, 25(1), 224–229.

People are often reluctant to comply with social causes because doing so may involve personal sacrifices of time, money, and effort for benefits that are shared by other members of society. In an effort to increase compliance, government agencies and public institutions sometimes employ financial tools to promote social causes. However, employing financial tools to induce prosocial behavior is expensive and often ineffective. We propose that anthropomorphizing a social cause is a practical and inexpensive tool for increasing compliance with it. Across three prosocial contexts, we found that individuals exposed to a message from an anthropomorphized social cause, compared with individuals exposed to a message relating to a nonanthropomorphized social cause, were more willing to comply with the message. This effect was mediated by feelings of anticipatory guilt experienced when they considered the likely consequences of not complying with the cause. The theoretical and practical implications of these findings are discussed.

In this study, we adopted a food-waste composting campaign. A total of 104 undergraduates (54% female and 46% male; mean age = 19.8 years) participated in return for course credit. Participants in the anthropomorphism condition were exposed to a campaign poster showing a garbage bin with humanlike features of eyes, a nose, and a mouth alongside the caption, “Please feed me food waste only!” Participants in the nonanthropomorphism condition were shown a campaign poster in which the garbage bin lacked humanlike features and was accompanied by the caption, “Please put food waste in only!”. Participants completed a measure of expected compliance with the campaign (α = .89) using response scales from 1 (very unlikely) to 9 (very likely). In addition, we employed a 4-item measure of anticipatory guilt adapted from Cotte, Coulter, and Moore (2005). The four items assessed the degree of guilt, shame, responsibility, and accountability, respectively, that participants would feel if they did not comply with the campaign and were administered with 9-point scales (α = .89).

As expected, we found increased compliance in the anthropomorphism condition (M = 6.99, SD = 1.62) compared with the nonanthropomorphism condition (M = 6.24, SD = 1.80), β = 0.22, SE = 0.34, p < .05. Moreover, anticipatory guilt was higher in the anthropomorphism condition (M = 5.16, SD = 1.39) compared with the nonanthropomorphism condition (M = 4.49, SD = 1.64), β = 0.22, SE = 0.30, p < .05, which in turn resulted in an increased level of compliance, β = 0.45, SE = 0.10, p < .001. When we controlled for anticipatory guilt, the direct effect of anthropomorphism on compliance was no longer significant, β = 0.12, SE = 0.32, p = .17, Sobel z = 2.04, p < .05, which suggests that anticipatory guilt mediated the effect of anthropomorphism on compliance. 

Chinese love plastic

Chinese government tries hard to reduce plastic waste. Recently, it banned plastic waste import. According to financial times, half of the UK plastic waste need to find alternative places desperately.

In contrast, Chinese people seem to overuse plastics. In Shenzhen, for instance, plates are often wrapped with plastic packages. We should tear it down and throw it away. Sometimes, plastic gloves are provided at the restaurants. We wear the gloves when eating bread.

I suspect Chinese people are addicted to plastics probably because they consider plastics cleaner and safer than water or napkins. If we aim to reduce plastic consumption in China, we should consider the Chinese psychology about plastics seriously.

Do we need floor signage?

We now see a wide variety of floor signage. In Singapore, there is a yellow-painted footstep on the right side of the paved road at the Marina Bay. Since this road is crowded by runners, this signage probably helps them run on the right side of the road.

 

 

In Shenzhen, China, there are orange-colored lines at the subway stations. Since many people are in a hurry, these lines help them not to rush forward when the train is coming, and wait for the next train if they cannot get on.

 

 

Although floor signage is visually salient, I wonder whether this is needed to change our behavior, because we learn rules naturally. We learn how to avoid bumping into other runners when running on a narrow road and we also learn how to navigate a huge crowd to get on a train. Although I am a strong supporter of behavior economics and nudge, I believe some nudges interfere with learning. Not surprisingly, some people argue that behavioral economics are not always as effective as thought (Why nudges hardly help)(The dark side of nudging). We need to study more about which specific nudges are ineffective and how we can modify these nudges.

 

Three escalating numbers are enough to teach moral behavior

In Singapore, we should pay fine when behaving inappropriately in subway: S$500 when eating or drinking, S$1000 when smoking, and S$5000 when using flammable goods. Interestingly, eating durians is also inappropriate but the fine amount of doing so is not clarified. I suspect that Singapore government seems to know intuitively that people follow rules if they see a set of three escalating numbers.

Verbal instructions do not work

People often use verbal signs to give instructions to others. The store owner posts a sign on the window saying, “This is a window, please use the door.” Government officers paint “Look Right” at the pedestrian crossing. However, I have observed numerous store visitors and pedestrians mistakenly push or slide the window and look left before crossing the road. In these cases, a visual signage might work better to attract their attention and guide their behavior.

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DML_London_Road

Traffic light labels help us drink less wine

People often do things while drunk that they regret when they sober up. Opening expensive wines is one of them. In order to solve this problem and, more academically speaking, to overcome the hot-cold empathy gap (proposed by George Loewenstein), I adopted traffic light system.

I place red sticky notes on the definitely expensive wines that I should NOT open while drunk. Yellow sticky notes go for the relatively expensive wines that I stop and, hopefully, think once more while drunk. Daily wines have no sticky notes. Thanks to this simple traffic light system, I regret less in the morning. 🙂

DML_Wine label