Janet Schwartz

Healthier by Precommitment

We tested a voluntary self-control commitment device to help grocery shoppers make healthier food purchases. Participants, who were already enrolled in a large-scale incentive program that discounts the price of eligible groceries by 25%, were offered the chance to put their discount on the line. Agreeing households pledged that they would increase their purchases of healthy food by 5 percentage points above their household baseline for each of 6 months. If they reached that goal, their discount was awarded as usual; otherwise, their discount was forfeited for that month. Thirty-six percent of households that were offered the binding commitment agreed; they subsequently showed an average 3.5-percentage-point increase in healthy grocery items purchased in each of the 6 months; households that declined the commitment and control-group households that were given a hypothetical option to precommit did not show such an increase. These results suggest that self-aware consumers will seize opportunities to create restrictive choice environments for themselves, even at some risk of financial loss.

From the Commercial to the Communal: Reframing Taboo Trade-Offs in Religious and Pharmaceutical Marketing

Although consumers typically expect organizations to profit from marketing goods and services, they also believe that certain organizations, like those that focus on religion and health, should prioritize communal obligations. Indeed, consumers may find it morally distressing when communally focused organizations use overtly commercial marketing strategies like rebranding or value-based pricing. We demonstrate how moral distress and consumer backlash result from such taboo trade-offs and investigate when communal-sharing rhetoric for religious and pharmaceutical marketing reduces distress. Communal justifications used by communally focused organizations are particularly effective when consumers are not closely monitoring the motives of the organization or when the product is need-based. However, communal justifications become less effective and market-pricing justifications become more effective when consumers are attuned to the persuasive intentions of the organization. Implications for consumer goals are discussed.

Are Consumers Too Trusting? The Effects of Relationships with Expert Advisers

Many important and complex consumer decisions rely on the advice of trusted professional experts. Many experts, however, such as doctors, financial advisers, and accountants, may be prone to conflicts of interest. As such, consumers may seek a second opinion. A series of studies investigate consumers’ reluctance to seek additional advice in the context of having an ongoing relationship with one expert service provider. The authors find evidence in health care claims that long-term relationships contribute to more expensive, but not necessarily better, treatment. In addition, a series of experiments show that people recognize when they could benefit from a second opinion but are more reluctant to do so when thinking about their own providers rather than someone elses. Further studies test a relationship maintenance hypothesis and show that consumers’ reluctance to seek second opinions is partially driven by their motivation to preserve relationship harmony, even when it is at their own personal expense and well-being. Taken together, these results provide important insight into the potential limitations and consequences of longstanding relationships between consumers and experts.

Better Medicine by Default

Background. American health care is transitioning to electronic physician ordering. These computerized systems are unique because they allow custom order interfaces. Although these systems provide great benefits, there are also potential pitfalls, as the behavioral sciences have shown that the very format of electronic interfaces can influence decision making. The current research specifically examines how defaults in electronic order templates affect physicians’ treatment decisions and medical errors. Methods. Forty-five medical residents completed order sets for 3 medical case studies. Participants were randomly assigned to receive order sets with either “opt-in” defaults (options visible but unselected) or “opt-out” defaults (options visible and preselected). Results compare error rates between conditions and examine the type and severity of errors most often made with opt-in versus opt-out defaults. Results. Opt-out defaults resulted in a greater number of items ordered and specifically increased commission errors (overordering) compared with opt-in defaults. However, while opt-in defaults resulted in fewer orders, they also increased omission errors. When the severity of the errors is taken into account, the default effects seem limited to less severe errors. Conclusion. The defaults used in electronic order sets influence medical treatment decisions when the consequences to a patient’s health are low. This pattern suggests that physicians cognitively override incorrect default choices but only to a point, and it implies tradeoffs that maximize accuracy and minimize cognitive effort. Results indicate that defaults for low-impact items on electronic templates warrant careful attention because physicians are unlikely to override them.

What Are Likes Worth? A Facebook Page Field Experiment

Despite the tremendous resources devoted to marketing on Facebook, little is known about its actual effect on customers. Specifically, can Facebook page likes affect offline customer behavior, and if so, how? To answer these questions, the authors conduct a field experiment on acquired Facebook page likes and find them to have a positive causal effect on offline customer behavior. Importantly, these likes are found to be most effective when the Facebook page is used as a platform for firm-initiated promotional communications. No effect of acquired page likes is found when customers interact organically with the firms page, but a significant effect is found when the firm pays to boost its page posts and thus uses its Facebook page as a platform for paid advertising. These results demonstrate the value of likes beyond Facebook activity itself and highlight the conditions under which acquiring likes is most valuable for firms.

Preference reversals resulting from a market value heuristic

Two studies demonstrated preference reversals using consumer products. Some subjects made a choice between a pair of food or hygiene products while others assigned minimum selling prices to each product. Product pairs were selected such that one item had a high market price but was undesirable (e.g. eggplant roulettes) while the other item had a low market price but was desirable (e.g. a can of soda). As predicted, most subjects choose the low market price/desirable item, but the high market price/undesirable item was assigned a higher minimum selling price. Experiment 1 used a hypothetical questionnaire, while in Experiment 2 responses had real consequences. The results suggest a market value heuristic such that when decision makers are unsure of how to translate their preference into a specific dollar amount they substitute the products market price for their own preference. The implication of this heuristic is that if merchants consistently set the retail price of a particular product at a certain level, consumers will use that retail price as the basis of their pricing evaluations and will come to value the product at the retail price.

The effects of accountability on bias in physician decision making: Going from bad to worse

Members of the Iowa Academy of Family Physicians participated in a survey study in which they were asked to make hypothetical decisions in either high- or low-conflict treatment conditions. In the low-conflict treatment condition the options were a common medication with a referral or a referral only. In the high-conflict treatment condition the same two options were given plus another attractive medication. In addition, we manipulated accountability by asking half of the participants to provide a written defense of their treatment options, which they would then agree to discuss at a later time. The results showed that physicians in the high-conflict condition chose the referral-only option significantly more than the physicians in the low-conflict condition, thus violating the normative rule of regularity. Moreover, that pattern was significantly amplified for physicians who were held accountable for their treatment decisions. These findings replicate and extend previous research and are discussed within the framework of reason-based choice.

Gain Without Pain: The Extended Effects of a Behavioral Health Intervention

We examine the extended effects of an incentive-based behavioral health intervention designed to improve nutrition behavior. Although the intervention successfully improved the target behavior, less is known about any spillovers, positive or negative, that impacted the program’s net benefit. This novel examination presents an opportunity to advance our knowledge of this important question, particularly because many theories predict that balancing behaviors in other domains (e.g., reduced exercise) can occur. Our results show a positive and long-lasting persistence effect for the treatment group, even after the incentive was removed. Moreover, we observe no negative spillover effects into related domains such as exercise, and no negative impact on customer loyalty. These results support the use of incentive-based interventions and highlight the importance, for both theory and practice, of examining their extended effects. This paper was accepted by Uri Gneezy, behavioral economics .

Actor–observer differences in frequency-of-use estimates: Sometimes strangers know us better than ourselves

People make optimistic predictions about themselves; they expect relationships to last longer, tasks to take less time, and things to turn out generally better than they will. In contrast, predictions about others are more realistic, but lack discriminatory power. We investigated first- and third-party predictions for holiday gifts, and how the actors own prediction influences the observers prediction. As expected, actors’ predictions were optimistic but showed discrimination, while observer accuracy depended on access to the actors prediction. Observers who saw the actors prediction showed no optimism but similar discrimination, while other observers showed an optimistic bias but no discrimination. These results suggest that predictions allow efficient use of an anchor-and-adjust strategy, while their absence leads observers to use projection.

A behavioral blueprint for improving health care policy

Behavioral policy to improve health and health care often relies on interventions, such as nudges, which target individual behaviors. But the most promising applications of behavioral insights in this area involve more far-reaching and systemic interventions. In this article, we propose a series of policies inspired by behavioral research that we believe offer the greatest potential for success. These include interventions to improve health-related behaviors, health insurance access, decisions about insurance plans, end-of-life care, and rates of medical (for example, organ and blood) donation. We conclude with a discussion of new technologies, such as electronic medical records and web- or mobile-based decision apps, which can enhance doctor and patient adherence to best medical practices. These technologies, however, also pose new challenges that can undermine the effectiveness of medical care delivery.