In this episode, Dr. Scott Halpern talks about health economics and nudges, a concept in health economics. He is the founding Director of the Palliative and Advanced Illness Research (PAIR) Center, which generates evidence to advance policies and practices that improve the lives of all people affected by serious illness. He is also the founding Director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) program, the nation’s only program that applies behavioral economic principles to understand and improve upon the health decisions made by seriously ill patients, their caregivers, and their clinicians.
[1:05] What is nudging? What hard choices as a physician do you have to make?
- Nudge is a feature of choice which foreseeably or predictably changes the choice of a person. It does not restrict or change incentives of choosing one choice or another. They pervade us, the choice environment can impact decision we make (from choosing food in a buffet to type of end-of-life care)
- Can be used in healthcare to change clinician behavior EHR and patient behavior through advance directives
[2:58] Scenario – DNR/DNI and CPR when a patient’s heart dies
- By explaining the risks that are inherent in the procedure, it is easier to unpack which choices have /really/ been restricted and how it can fully increase the autonomy of the patient
[6:04] How can we get more people to plan what comes after their death? How can we incentivize advance care planning?
- Lots of policy planning to incentivize the filling out the advance care planning (since the early 1990s and recently as well), but we don’t have a lot to show for those efforts. We can use newer technologies to plan for our deaths.
- It is also more existential planning for one’s death so it is harder to implement than other behaviors, because the benefits are in the future rather than in the present. We can use nudges to point patients towards thinking about how they want to die in terms of the care they receive. This may double the engagement in planning for their death.
[10:30] What pernicious habits persist in health care that are propagated by clinicians and why do they persist in the populace?
- It’s a complicated topic. Clinician behavior is driven by training paradigms, culture, and what is easiest to do. It is easier to perform a procedure or give a medicine than having an in-depth conversation about whether the treatment is appropriate.
- Need to change behavior through any means possible to make it easier and more likely that these conversations will happen.
[13:16] When does a nudge become a push?
[15:46] What advances do you see in care coordination in the next 5 years?
- We need to do better in managing patients in the home rather than the hospital, which has been a trend in American health care delivery for the past decade.
- Managing transitions of care and managing health in the home of aging patients is the most important which would give options instead of rushing to the ER
[18:21] Why are our health care costs so high?
[24:31] How does Dr. Halpern manage to research many facets of health care?
[26:01] Would you have done anything differently in your journey?
[27:00] What advice would you give to a medical student today?
[29:07] Flipped interview question: