Understanding Irrational Behavior

Understanding Irrational Behavior

Behavioral economics is a field which attempts to understand human behavior by merging economic and psychological principles. In health care, behavioral economics may be used to understand maladaptive or unhealthy behavior which may be difficulty to explain using rationality alone. For example, perhaps the most important behavioral tendency or bias which effects health care, is the tendency of individuals to disproportionately value present benefits and costs over future benefits and costs. This may be at least partially rational, for the future is never guaranteed. Still, starting an exercise routine in a week often sounds more reasonable than starting today, and eating what you crave has a more tangible benefit then the seemingly abstract health risks associated with having a poor diet. For those of us who are not economists the concept that humans make poor or irrational choices is not difficult to accept.

Still, this kind of bias is particularly influential when health conditions do not produce detectable symptoms, as is the case in the development and exacerbation of many chronic diseases. Take for example, hypertension. Chances are taking your hypertension medication does not make you feel any better, and may even produce side effects. Not taking your medication on the other hand has the potential to save you time, and money. Tragically, it is difficult to appreciate that the cost of these tangible benefits could be a heart attack and an untimely death. This is not an exaggeration as hypertension is the greatest risk factor for having a heart attack. Still, 80% of patients on blood pressure medication fail to take their medication more than four out of five days.3 As was mentioned in a previous post this is kind of behavior (medication non-adherence) contributes to between 100 and 300 billion dollars of unnecessary medical spending in the US every year.4 When researchers interviewed these patients the most common reason for not taking their medication as prescribed, was not that they did not like the side effects (6%), or that they could not afford the medication (2%), but that they forgot (55%).5

Forgetting is fair in a society with a million to do’s and the last thing individuals need is more on their plate. What’s more most individuals already know that when they forget to take their medication, to follow up with doctors appointments, or to get a colonoscopy, mammography, or other recommended screening test, they are risking their well being. But the truth is many of us don’t care.

Why? Perhaps we don’t care because the buy in is just too high. Perhaps being healthy appears to threaten our sense of identity or autonomy, because somewhere at the top of all of our ‘to do ‘ lists is the commitment to be true to ourselves, and a result, right or wrong, to some extent we oppose change. Or maybe we feel that the effort required is too great, or we would just rather not know.

Individuals have to prioritize their goals for promoting their health, as well as for choosing how to be responsible contributors to society. So why should changing the culture of health, and individual participation in health care be a priority? Because the predominating priorities of adults in the US result in unnecessary suffering, unnecissary years of life lost, a decreased quality of life for aging populations, and unsustainable healthcare spending.

For the sake of your own health, and as a social cause – doing your part to make sure health care dollars go to the best health care causes- consider making health and health care improvement a part your life, in any way which is manageable for you.

References
  1. Johnson EJ, Hershey J, Meszaros J, Kunreuther H. Framing, probability distortions, and insurance decisions.  J Risk Uncertainty. 1993;735-53.
  2. Madrian BC, Shea DF. The power of suggestion: inertia in 401(k) participation and savings behavior.  Q J Econ. 2001;116(4):1149-1187.
  3. Monane  M, Bohn  RL, Gurwitz  JH, Glynn  RJ, Levin  R, Avorn  J. The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly. Am J Hypertens 1997;10697- 704.
  4. Bosworth, Hayden B. Medication Adherence: Making the Case for Increased Awareness. Duke University Medical Center; National Consumers League. ScriptYourFuture.org.
  5. Cheng JW, Kalis MM, Feifer S. Patient-reported adherence to guidelines of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Pharmacotherapy. 2001;21:828–841.

 

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