FROM A NUDGE TO A SHOVE: HOW BIG A ROLE FOR SHARED DECISION MAKING

Poor adherence is responsible for about half of medication-related hospital admissions, costing $100 billion a year, yet few interventions to date have effectively addressed this problem.Adherence is particularly important for older adults; more than 50% of older adults take five or more medications on a regular basis. Finding ways to change health-related behaviors is a major challenge for health policy yet there is a debate as to how forcefully to intervene. Behavioral economics has been instrumental in developing less forceful mechanisms for encouraging healthy behaviors.  These mechanisms have been famously described as “nudges.”Yet even within behavioral economics, more forceful incentive schemes are being developed in areas as diverse as nutrition and obesity to employer wellness and adherence. Our speakers will present various examples where there is a tension between subtle and more forceful incentives for behavior change and the relative effectiveness among them.