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  5. Health-Related Information, Incentives and Behavior
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Health-Related Information, Incentives and Behavior

Paper Session

Sunday, Jan. 9, 2022 12:15 PM - 2:15 PM (EST)

Hosted By: International Health Economics Association
  • Chair: David Bishai, Johns Hopkins University

Stronger Together: Experimental Evidence on Group Incentives for Preventive Health Services

Mylene Lagarde
,
London School of Economics

Abstract

Although team incentives are seen as powerful tools to leverage the power of social groups, they have rarely been used to encourage behaviours outside firms. In this study, we partnered with a micro-finance organisation in El Salvador to test if the power of group incentives in existing social networks to encourage the demand for preventive healthcare services in a population at risk of cardio-vascular diseases (CVD).
We enrolled 400 groups of 3-6 members jointly liable for the repayment of a micro-credit into a cluster-randomised trial. We gave them information about risk factors and benefits of routine check-ups, and a free voucher for a medical check-up including a blood test and medical consultation. Each group was then randomly allocated to receiving no incentive, individual incentives or team incentives for using the voucher. In addition, we cross-randomised two incentive designs: a small reward worth US$5 per person for using the voucher (or, in the case of team incentives, if all members of a group used their voucher), or a lottery with a 5% chance of winning a prize of USD$100.

Overcoming Information Gaps and the Risk-Income Tradeoff in Transactional Sex with HIV Self-Tests: Behavioral Responses to New Diagnostics

Ruchi Mahadeshwar
,
Brown University
Kawango Agot
,
Kenyan Impact Research and Development Organization
Harsha Thirumurthy
,
University of Pennsylvania

Abstract

In high HIV prevalence settings with transactional sex, we study how the introduction of HIV self-tests affects the tradeoff that women face between income and HIV risk. By facilitating partner testing and screening, such an intervention may reduce women’s overall health risk and income. However, using experimental data from Kenya we find that access to free self-tests among HIV-negative women results in higher income from transactional sex. The intervention doubled women’s knowledge of their partners' status, and consistent with theoretical predictions, knowledge of partners’ HIV-negative status led to lower condom use and higher income, with no effect on health risks.

Mission Motivation and Public Sector Performance: Experimental Evidence from Pakistan

Muhammad Yasir Khan
,
University of Pittsburgh

Abstract

This paper studies whether public sector organizations can improve the performance of their workers by investing in employees' mission motivation and compares its effectiveness with performance-linked incentives. In partnership with the Health Department in one district of Pakistan, I randomize Community Health Workers into receiving mission strengthening training, performance-linked financial incentives, or both. The mission treatment improves worker performance across incentivized (home visits) and non-incentivized tasks, while financial incentives improve performance only on the incentivized task. Financial incentives also become less effective at increasing home visits when combined with the mission treatment. Finally, the mission treatment improves downstream child health outcomes---there is a lower prevalence of diarrhea and higher vaccination rates. A survey of workers and a lab-in-the-field activity reveal that mission treatment activates intrinsic motivations of workers and makes them more altruistic towards their job. These results highlight that promoting an organization's mission can be a useful alternative to providing financial incentives to improve public sector performance, especially in low-income countries.

Patient Movement, Prescription Behaviour, and Generic Drug Diffusion: Evidence from Finnish Healthcare Market

Zhengnan Zhu
,
Imperial College London
Marisa Miraldo
,
Imperial College London
Renata Kosova
,
Imperial College London

Abstract

In this paper we measure the impact of information propagating through patients and professional networks on the diffusion of generic drugs. To do so we exploit patient movements across different physicians to identify the impact of the information that flow among physician peers connected through patients, and analyse the impact of patient-sharing network on physicians’ prescription patterns. We assume that connections between physicians occur through the patients they share. When patients move between locations and/or change physicians, the new physician gains the knowledge about the drug choices made by patient’s prior physicians, as well as the effectiveness of previous treatments prescribed by prior physicians. In addition, patients can share their own knowledge, perceptions or experiences when taking the prescribed drug or treatment with a new physician.
The outcome variable is the prescription patterns measured by physicians’ choices towards generic versus branded drugs within the same Anatomical Therapeutic Class. We leverage a unique dataset with daily prescription level data between 2000-2011 covering universe of statins prescriptions in Finland. The data contains detailed information about physician characteristics, patient characteristics and prescribed drug characteristics. Since it covers the entire population in Finland and includes both prescribed and dispensing data it also enables computing market prices and volumes. The institutional settings of Finnish health-care system allow us to exploit the exogenous patient movements across hospital districts as the identification strategy in order to separate and analyse different information channels. We divide new patients into three groups: new patients who just entered the population of patients treated by statins, new patients moving within the same hospital district, and new patients moving across different hospital districts.

Discussant(s)
Omar Galarraga
,
Brown University
Jacob Bor
,
Boston University
David Bishai
,
Johns Hopkins University
Jennifer Kwok
,
University of Illinois-Chicago
JEL Classifications
  • I1 - Health
  • I1 - Health