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Active choice, implicit defaults, and the incentive to choose
John Beshears1, James J Choi2, David Laibson3
1Harvard Business School and NBER, Soldiers Field, Boston, MA 02163, United States.
Organizational Behavior and Human Decision Processes
|May 14, 2021
Summary
Requiring an active choice for prescription fulfillment, rather than opt-in, significantly increased home delivery uptake. An implicit default nudged users toward making a decision, improving program engagement.
Area of Science:
- Behavioral Economics
- Health Services Research
- Public Health Policy
Background:
- Home-delivered prescriptions offer cost savings (no delivery charge, lower copayments) compared to pharmacy pick-up.
- Opt-in programs for home prescription delivery show low uptake rates (only 6%).
- Understanding factors influencing prescription fulfillment choices is crucial for optimizing healthcare access and cost-effectiveness.
Purpose of the Study:
- To evaluate the impact of an active choice program on prescription fulfillment method selection.
- To assess the effectiveness of an implicit default strategy in driving user decisions for home delivery versus pharmacy pick-up.
- To analyze how financial incentives influence individuals' choices in prescription fulfillment.
Main Methods:
- A program was implemented requiring active choice between home delivery and pharmacy pick-up for insurance eligibility.
- An implicit default (pharmacy pick-up without insurance subsidies) was established for non-responders.
- Choice outcomes and influencing factors were analyzed among eligible employees.
Main Results:
- Active choice led to a 42% uptake of home delivery and 39% for pharmacy pick-up.
- 19% of individuals made no active choice and defaulted to pharmacy pick-up without subsidies.
- Individuals with greater financial benefit from home delivery were more likely to choose it; those benefiting least from subsidies were more likely to default.
Conclusions:
- Mandating active choice significantly increases engagement with home prescription delivery services.
- Implicit defaults serve as a powerful tool in choice architecture, incentivizing active decision-making.
- Choice design can effectively steer individuals toward more cost-effective and convenient prescription fulfillment methods.
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