A behavioral blueprint for improving health care policy

by George Loewenstein, David Hagmann, Janet Schwartz, Keith Ericson, Saurabh Bhargava, Jennifer Blumenthal-Barby, Thomas D’Aunno, Ben Handel, Jonathan Kolstad, David Nussbaum, Victoria Shaffer, Jonathan Skinner, Peter Ubel, Brian J. Zikmund-Fisher
August 15, 2017

Author Note

We thank Eric Johnson for helpful comments on
the article and participants in the early stages of
this endeavor: Kate Wessels, Katherine Baicker,
Laszlo Bock, Troy Brennan, Rodney Ghali, Robert
Krughoff, Tova Levin, Maureen Pirog, Robert
Sahadevan, Kevin Volpp, Jessica Wisdom, and
Wendy Wood.

Author Affiliation

The authors were members of the BSPA Working
group on health.
Loewenstein and Hagmann: Carnegie Mellon
University. Schwartz: Tulane University. Ericson:
Boston University. Kessler: University of Pennsylvania.
Bhargava: Carnegie Mellon University.
Blumenthal-Barby: Baylor College of Medicine.
D’Aunno: New York University. Handel and
Kolstad: University of California, Berkeley. Nussbaum:
University of Chicago and Behavioral
Science and Policy Association. Shaffer: University
of Missouri. Skinner: Dartmouth College.
Ubel: Duke University. Zikmund-Fisher: University
of Michigan. Corresponding author’s e-mail:


1. Squires, D., & Anderson, C. (2015). U.S.
health care from a global perspective:
Spending, use of services, prices, and
health in 13 countries. Retrieved from
The Commonwealth Fund website:
2. Case, A., & Deaton, A. (2015). Rising
morbidity and mortality in midlife
among White non-Hispanic Americans
in the 21st century. Proceedings of the
National Academy of Sciences, USA, 112,
3. Chetty, R., Stepner, M., Abraham, S., Lin,
S., Scuderi, B., Turner, N., . . . Cutler, D.
(2016). The association between income
and life expectancy in the United States,
2001–2014. JAMA, 315, 1750–1766.
4. Clarke, T. C., Ward, B. W., Norris, T.,
& Schiller, J. S. (2017). Early release of
selected estimates based on data from
the National Health Interview Survey,
January–September 2016: Lack of
health insurance coverage and type of
coverage. Retrieved from Centers for
Disease Control and Prevention website:
5. Thaler, R. H., & Benartzi, S. (2004). Save
More Tomorrow: Using behavioral
economics to increase employee saving.
Journal of Political Economy, 112(S1),
6. Mokdad, A. H., Marks, J. S., Stroup, D. F.,
& Gerberding, J. L. (2004). Actual causes
of death in the United States, 2000.
JAMA, 291, 1238–1245.
7. Xu, X., Bishop, E. E., Kennedy, S. M.,
Simpson, S. A., & Pechacek, T. F.
(2015). Annual healthcare spending
attributable to cigarette smoking: An
update. American Journal of Preventive
Medicine, 48, 326–333.
8. Hughes, J. R. (2003). Motivating and
helping smokers to stop smoking.
Journal of General Internal Medicine, 18,
9. Ogden, C. L., Carroll, M. D., Curtin, L. R.,
McDowell, M. A., Tabak, C. J., & Flegal, K.
M. (2006). Prevalence of overweight and
obesity in the United States, 1999–2004.
JAMA, 295, 1549–1555.
10. Flegal, K. M., Graubard, B. I., Williamson,
D. F., & Gail, M. H. (2005). Excess
deaths associated with underweight,
overweight, and obesity. JAMA, 293,
11. Schroeder, S. A. (2007). We can do
better—Improving the health of the
American people. New England Journal
of Medicine, 357, 1221–1228.
12. McGinnis, J. M. (2013, September).
Actual causes of death, 1990–2010.
Paper presented at the Workshop on
Determinants of Premature Mortality,
National Research Council, Washington,
13. Milkman, K. L., Minson, J. A., & Volpp, K.
G. M. (2014). Holding the Hunger Games
hostage at the gym: An evaluation of
temptation bundling. Management
Science, 60, 283–299.
14. Giné, X., Karlan, D., & Zinman, J. (2010).
Put your money where your butt is:
A commitment contract for smoking
cessation. American Economic Journal:
Applied Economics, 2(4), 213–235.
15. Volpp, K. G., Troxel, A. B., Pauly, M.
V., Glick, H. A., Puig, A., Asch, D. A.,
. . . Audrain-McGovern, J. (2009). A
randomized, controlled trial of financial
incentives for smoking cessation. New
England Journal of Medicine, 360,
16. Higgins, S. T., Heil, S. H., Solomon, L. J.,
Bernstein, I. M., Lussier, J. P., Abel, R. L.,
. . . Badger, G. J. (2004). A pilot study on
voucher-based incentives to promote
abstinence from cigarette smoking
during pregnancy and postpartum.
Nicotine & Tobacco Research, 6,
17. Volpp, K. G., John, L. K., Troxel, A.
B., Norton, L., Fassbender, J., &
Loewenstein, G. (2008). Financial
incentive–based approaches for weight
loss: A randomized trial. JAMA, 300,
18. Mochon, D., Schwartz, J., Maroba, J.,
Patel, D., & Ariely, D. (2016). Gain without
pain: The extended effects of a health
intervention. Management Science, 63,
19. Schwartz, J., Mochon, D., Wyper,
L., Maroba, J., Patel, D., & Ariely, D.
(2014). Healthier by precommitment.
Psychological Science, 25, 538–546.
20. Schwartz, J., Riis, J., Elbel, B., & Ariely D.
(2012). Inviting consumers to downsize
fast-food portions significantly reduces
calorie consumption. Health Affairs, 31,
21. Kullgren, J. T., Troxel, A. B., Loewenstein,
G., Asch, D. A., Norton, L. A., Wesby,
L., . . . Volpp, K. G. (2013). Individual vs.
group-based incentives for weight loss:
A randomized, controlled trial. Annals of
Internal Medicine, 158, 505–514.
22. Hersey, J. C., Wohlgenant, K. C.,
Arsenault, J. E., Kosa, K. M., & Muth, M.
K. (2013). Effects of front-of-package
and shelf nutrition labeling systems on
consumers. Nutrition Reviews, 71, 1–14.
23. Hanks, A. S., Just, D. R., & Wansink, B.
(2016). Smarter lunchrooms can address
new school lunchroom guidelines
and childhood obesity. The Journal of
Pediatrics, 162, 867–869.
24. Wansink, B. (2004). Environmental
factors that increase the food intake
and consumption volume of unknowing
consumers. Annual Review of Nutrition,
24, 455–479.
25. Arno, A., & Thomas, S. (2016). The
efficacy of nudge theory strategies in
influencing adult dietary behaviour: A
systematic review and meta-analysis.
BMC Public Health, 16, Article 676.
26. Mattke, S., Liu, H., Caloyeras, J.
P., Huang, C. Y., Van Busum, K. R.,
Khodyakov, D., & Shier, V. (2013).
Workplace Wellness Programs Study:
Final report. Retrieved from RAND
Corporation website: http://www.rand.
27. Gubler, T., Larkin, I., & Pierce, L. (2017).
Doing well by making well: The impact
of corporate wellness programs on
employee productivity. Retrieved from
28. Cohen, A., & Einav, L. (2003). The effects
of mandatory seat belt laws on driving
behavior and traffic fatalities. Review of
Economics and Statistics, 85, 828–843.
29. Halpern, D., & Sanders, M. (2016).
Nudging by government: Progress,
impact, & lessons learned. Behavioral
Science & Policy, 2(2), 53–65.
30. Blavin, F., Dorn, S., & Dev, J. (2014).
Using behavioral economics to inform
the integration of human services and
health programs under the Affordable
Care Act. Retrieved from Assistant
Secretary for Planning and Evaluation
website: https://aspe.hhs.gov/pdf-report/
31. Levitt, L., Claxton, G., Damico, A., & Cox
C. (2016). Assessing ACA marketplace
enrollment [Issue brief]. Retrieved from
Kaiser Family Foundation website:
32. Kenney, G. M., Lynch, V., Haley, J. M., &
Huntress, M. (2013). Variation in Medicaid
eligibility and participation among
adults: Implications for the Affordable
Care Act. Inquiry, 49, 231–253.
33. Bhargava, S., & Manoli, D. (2015).
Psychological frictions and the
64 behavioral science & policy | volume 3 issue 1 2017
incomplete take-up of social benefits:
Evidence from an IRS field experiment.
The American Economic Review, 105,
34. Baicker, K., Congdon, W. J., &
Mullainathan, S. (2012). Health insurance
coverage and take-up: Lessons from
behavioral economics. Milbank
Quarterly, 90, 107–134.
35. Johnson, E. J., Hassin, R., Baker,
T., Bajger, A. T., & Treuer, G. (2013).
Can consumers make affordable
care affordable? The value of choice
architecture. PLOS ONE, 8(12), Article
36. Loewenstein, G., Friedman, J. Y.,
McGill, B., Ahmad, S., Linck, S., Sinkula,
S., . . . Volpp, K. G. (2013). Consumers’
misunderstanding of health insurance.
Journal of Health Economics, 32,
37. Handel, B. R. (2013). Adverse selection
and inertia in health insurance markets:
When nudging hurts. American
Economic Review, 103, 2643–2682.
38. Bhargava, S., Loewenstein, G., & Sydnor,
J. (in press). Choose to lose: Health plan
choices from a menu with dominated
options. The Quarterly Journal of
39. Schwartz, J., Hadler, N. M., Ariely,
D., Huber, J. C., & Emerick, T. (2013).
Choosing among employer-sponsored
health plans: What drives employee
choices? Journal of Occupational and
Environmental Medicine, 55, 305–309.
40. Ubel, P. A., Comerford, D. A., &
Johnson, E. (2015). Healthcare.gov 3.0—
Behavioral economics and insurance
exchanges. New England Journal
Medicine, 372, 695–698.
41. Bhargava, S., Loewenstein, G., &
Benartzi, S. (2017). The costs of poor
health (plan choices) and prescriptions
for reform. Behavioral Science & Policy,
3(1), 1–12.
42. Handel, B., & Kolstad, J. (2015). Getting
the most from marketplaces: Smart
policies on health insurance choice (The
Hamilton Project Discussion Paper 2015-
08). Retrieved from Brookings Institution
website: https://www.brookings.
43. Loewenstein, G., & Bhargava, S. (2016,
August 23). The simple case against
health insurance complexity. New
England Journal of Medicine Catalyst.
Retrieved from http://catalyst.nejm.
44. Ericson, K., & Starc, A. (2013). How
product standardization affects choice:
Evidence from the Massachusetts Health
Insurance Exchange (NBER Working
Paper No. 19527). Cambridge, MA:
National Bureau of Economic Research.
45. Humana. (n.d.). Humana Simplicity.
Retrieved from https://www.humana.
46. Larkin, I., & Loewenstein, G. (2017).
Business model–related conflicts
of interests in medicine: Problems
and potential solutions. JAMA, 317,
47. Combes, J. R., & Arespacochaga, E.
(2013, November). Appropriate use of
medical resources. Paper presented
at the American Hospital Association’s
Physician Leadership Forum, Chicago,
IL. Retrieved from http://www.aha.org/
48. Kolata, G. (2016, August 3). Why
“useless” surgery is still popular. The New
York Times. Retrieved from http://www.
49. Bundorf, M. K., Levin, J., & Mahoney, N.
(2012). Pricing and welfare in health plan
choice. American Economic Review,
102, 3214–3248.
50. Brot-Goldberg, Z. C., Chandra, A.,
Handel, B. R., & Kolstad, J. T. (in press).
What does a deductible do? The impact
of cost-sharing on health care prices,
quantities, and spending dynamics. The
Quarterly Journal of Economics.
51. McManis Consulting. (2011). The work
ahead: Activities and costs to develop
an accountable care organization
[White paper]. Retrieved from American
Hospital Association website: http://
52. McWilliams, J. M., Hatfield, L. A.,
Chernew, M. E., Landon, B. E., &
Schwartz, A. L. (2016). Early performance
of accountable care organizations in
Medicare. New England Journal of
Medicine, 374, 2357–2366.
53. Colla, C. H., Wennberg, D. E., Meara, E.,
Skinner, J. S., Gottlieb, D., Lewis, V. A., . . .
Fisher, E. S. (2012). Spending differences
associated with the Medicare Physician
Group Practice Demonstration. JAMA,
308, 1015–1023.
54. Nyweide, D. J., Lee, W., Cuerdon, T.
T., Pham, H. H., Cox, M., Rajkumar, R.,
& Conway, P. H. (2015). Association of
Pioneer Accountable Care Organizations
vs traditional Medicare fee for service
with spending, utilization, and patient
experience. JAMA, 313, 2152–2161.
55. Skinner, J., & Chandra, A. (2016). The
past and future of the Affordable Care
Act. JAMA, 316, 497–499.
56. Campbell, E. G., Rao, S. R., DesRoches,
C. M., Iezzoni, L. I., Vogeli, C., Bolcic-
Jankovic, D., & Miralles, P. D. (2010).
Physician professionalism and changes
in physician–industry relationships
from 2004 to 2009. Archives of Internal
Medicine, 170, 1820–1826.
57. Dana, J., & Loewenstein, G. (2003). A
social science perspective on gifts to
physicians from industry. JAMA, 290,
58. Brennan, T. A., Rothman, D. J., Blank, L.,
Blumenthal, D., Chimonas, S. C., Cohen,
J. J., . . . Smelser, N. (2006). Health
industry practices that create conflicts of
interest: A policy proposal for academic
medical centers. JAMA, 295, 429–433.
59. Institute of Medicine, Committee on
Conflict of Interest in Medical Research,
Education, and Practice. (2009).
Conflict of interest in medical research,
education, and practice (B. Lo & M. J.
Field, Eds.). Retrieved from http://www.
60. Larkin, I., Ang, D., Avorn, J., &
Kesselheim, A. S. (2014). Restrictions
on pharmaceutical detailing reduced
off-label prescribing of antidepressants
and antipsychotics in children. Health
Affairs, 33, 1014–1023.
61. Larkin, I., Ang, D., Steinhart, J.,
Chao, M., Patterson, M., Sah, S., . . .
Loewenstein, G. (2017). Association
between academic medical center
pharmaceutical detailing policies
and physician prescribing. JAMA, 317,
62. Sah, S., & Loewenstein, G. (2014).
Nothing to declare: Mandatory and
voluntary disclosure leads advisors to
avoid conflicts of interest. Psychological
Science, 25, 575–584.
63. Loewenstein, G., Sah, S., & Cain, D. M.
(2012). The unintended consequences of
conflict of interest disclosure. JAMA, 307,
64. Schwartz, J., Luce, M. F., & Ariely, D.
(2011). Are consumers too trusting?
The effects of relationships with expert
advisers. Journal of Marketing Research,
48, S163–S174.
65. Althabe, F., Belizan, J. M., Villar, J.,
Alexander, S., Bergel, E., Ramos, S., . . .
Kestler, E. (2004). Mandatory second
opinion to reduce rates of unnecessary
caesarean sections in Latin America:
A cluster randomised controlled trial.
Lancet, 363, 1934–1940.
a publication of the behavioral science & policy association 65
66. Kronz, J. D., Westra, W. H., & Epstein,
J. I. (1999). Mandatory second opinion
surgical pathology at a large referral
hospital. Cancer, 86, 2426–2435.
67. Hamady, Z. Z. R., Mather, N., Lansdown,
M. R., Davidson, L., & Maclennan, K. A.
(2005). Surgical pathological second
opinion in thyroid malignancy: Impact
on patients’ management and prognosis.
European Journal of Surgical Oncology,
31, 74–77.
68. American Board of Internal Medicine.
(n.d.). Choosing Wisely. Retrieved from

What We Do

69. Katz, J. N., Brophy, R. H., Chaisson, C.
E., de Chaves, L., Cole, B. J., Dahm, D.
L., . . . Losina, E. (2013). Surgery versus
physical therapy for a meniscal tear and
osteoarthritis. New England Journal of
Medicine, 368, 1675–1684.
70. Sihvonen, R., Paavola, M., Malmivaara,
A., Itälä, A., Joukainen, A., Nurmi, H., . .
. Järvinen, T. L. N. (2013). Arthroscopic
partial meniscectomy versus sham
surgery for a degenerative meniscal tear.
New England Journal of Medicine, 369,
71. de Koning, H. J., Boer, R., Warmerdam,
P. G., Beemsterboer, P. M. M., & van
der Maas, P. J. (1995). Quantitative
interpretation of age-specific mortality
reductions from the Swedish breast
cancer-screening trials. Journal of the
National Cancer Institute, 87, 1217–1223.
72. Ubel, P. A., Loewenstein, G., Scanlon, D.,
& Kamlet, M. (1996). Individual utilities
are inconsistent with rationing choices:
A partial explanation of why Oregon’s
cost-effectiveness list failed. Medical
Decision Making, 16, 108–116.
73. The Economist Intelligence Unit.
(2015). The 2015 Quality of Death
Index: Ranking palliative care across
the world. Retrieved from https://www.
74. Halpern, S. D., Loewenstein, G., Volpp,
K. G., Cooney, E., Vranas, K., Quill, C.
M., . . . Bryce, C. (2013). Default options
in advance directives influence how
patients set goals for end-of-life care.
Health Affairs, 32, 408–417.
75. Loewenstein, G., Bryce, C., Hagmann,
D., & Rajpal, S. (2015). Warning: You are
about to be nudged. Behavioral Science
& Policy, 1(1), 35–42.
76. Clayton, J. M., Butow, P. N., & Tattersall,
M. H. (2005). When and how to initiate
discussion about prognosis and
end-of-life issues with terminally ill
patients. Journal of Pain and Symptom
Management, 30, 132–144.
77. Christakis, N. A., & Lamont, E. B. (2000).
Extent and determinants of error in
doctors’ prognoses in terminally ill
patients: Prospective cohort study.
British Medical Journal, 320, 469–473.
78. Billings, J. A. (2012). The need for
safeguards in advance care planning.
Journal of General Internal Medicine, 27,
79. Fagerlin, A., & Schneider, C. E. (2004).
Enough: The failure of the living will.
Hastings Center Report, 34(2), 30–42.
80. Bernacki, R. E., & Block, S. D. (2014).
Communication about serious illness
care goals: A review and synthesis of
best practices. JAMA Internal Medicine,
174, 1994–2003.
81. The John A. Hartford Foundation.
(2016, December 1). Improving advance
care planning: Research results from
the “Conversation Starters” focus
groups and “Conversation Stopper”
physician survey [JAHF in the News
post]. Retrieved from http://www.
82. Schnitzler, M. A., Whiting, J. F.,
Brennan, D. C., Lentine, K. L., Desai, N.
M., Chapman, W., . . . Kalo, Z. (2005).
The life-years saved by a deceased
organ donor. American Journal of
Transplantation, 5, 2289–2296.
83. Dew, M. A., Switzer, G. E., Goycoolea,
J. M., Allen, A. S., DiMartini, A., Kormos,
R. L., & Griffith, B. P. (1997). Does
transplantation produce quality of life
benefits? A quantitative analysis of the
literature. Transplantation, 64, 1261–1273.
84. Rees, M. A., Schnitzler, M. A., Zavala,
E. Y., Cutler, J. A., Roth, A. E., Irwin, F.
D., . . . Leichtman, A. B. (2012). Call to
develop a standard acquisition charge
model for kidney paired donation.
American Journal of Transplantation, 12,
85. Roth, A. E. (2007). Repugnance as
a constraint on markets. Journal of
Economic Perspectives, 21, 37–58.
86. McGraw, A.P., Schwartz, J. A., & Tetlock,
P. (2012). From the commercial to the
communal: Reframing taboo tradeoffs
in religious and pharmaceutical
marketing. Journal of Consumer
Research, 39, 157–173.
87. Lacetera, N., & Macis, M. (2010). Social
image concerns and prosocial behavior:
Field evidence from a nonlinear
incentive scheme. Journal of Economic
Behavior & Organization, 76, 225–237.
88. Lacetera, N., & Macis, M. (2013). Time
for blood: The effect of paid leave
legislation on altruistic behavior. Journal
of Law, Economics, and Organization,
29, 1384–1420.
89. Lacetera, N., Macis, M., & Slonim, R.
(2012). Will there be blood? Incentives
and displacement effects in pro-social
behavior. American Economic Journal:
Economic Policy, 4(1), 186–223.
90. Kessler, J. B., & Roth, A. E. (2012). Organ
allocation policy and the decision to
donate. American Economic Review,
102, 2018–2047.
91. Kessler, J. B., & Roth, A. E. (2014).
Loopholes undermine donation: An
experiment motivated by an organ
donation priority loophole in Israel.
Journal of Public Economics, 114,
92. Kessler, J. B., & Roth, A. E. (2014).
Getting more organs for transplantation.
American Economic Review, 104,
93. Stoler, A., Kessler, J. B., Ashkenazi,
T., Roth, A. E., & Lavee, J. (2016).
Incentivizing organ donor registrations
with organ allocation priority. Health
Economics, 26, 500–510.
94. Stoler, A., Kessler, J. B., Ashkenazi,
T., Roth, A. E., & Lavee, J. (2016).
Incentivizing authorization for deceased
organ donation with organ allocation
priority: The first 5 years. American
Journal of Transplantation, 16,
95. Johnson, E. J., & Goldstein, D. (2003,
November 21). Do defaults save lives?
Science, 302, 1338–1339.
96. Shepherd, L., O’Carroll, R. E., &
Ferguson, E. (2014). An international
comparison of deceased and living
organ donation/transplant rates in opt-in
and opt-out systems: A panel study.
BMC Medicine, 12, Article 131.
97. Douglas, J. F., & Cronin, A. J. (2015).
The Human Transplantation (Wales) Act
2013: An act of encouragement, not
enforcement. Modern Law Review, 78,
324–348. doi:10.1111/1468-2230.12117
98. Kessler, J. B., & Roth, A. E. (2014). Don’t
take ‘no’ for an answer: An experiment
with actual organ donor registrations
(NBER Working Paper No. 20378).
Cambridge, MA: National Bureau of
Economic Research.
99. Keller, P. A., Harlam, B., Loewenstein, G.,
& Volpp, K. G. (2011). Enhanced active
choice: A new method to motivate
behavior change. Journal of Consumer
Psychology, 21, 376–383.
66 behavioral science & policy | volume 3 issue 1 2017
100. Behavioural Insights Team. (n.d.).
Applying behavioural insights to
organ donation: Preliminary results
from a randomised controlled trial.
Retrieved from https://www.gov.
101. Ansher, C. A., Ariely, D., Nagler, A.,
Rudd, M., Schwartz, J., & Shah, A.
(2014). Better medicine by default.
Medical Decision Making, 34, 147–158.
102. Meeker, D., Linder, J. A., Fox, C.
R., Friedberg, M. W., Persell, S. D.,
Goldstein, N. J., . . . Doctor, J. N. (2016).
Effect of behavioral interventions on
inappropriate antibiotic prescribing
among primary care practices: A
randomized clinical trial. JAMA, 315,
103. Malhotra, S., Cheriff, A. D., Gossey, J.
T., Cole, C. L., Kaushal, R., & Ancker, J.
S. (2016). Effects of an e-prescribing
interface redesign on rates of generic
drug prescribing: Exploiting default
options. Journal of the American
Medical Informatics Association, 23,
104. Chapman, G. B., Li, M., Leventhal,
H., & Leventhal, E. A. (2016). Default
clinic appointments promote
influenza vaccination uptake without
a displacement effect. Behavioral
Science & Policy, 2(2), 41–50.
105. Haynes, A. B., Weiser, T. G., Berry, W. R.,
Lipsitz, S. R., Breizat, A.-H. S., Dellinger,
E. P., . . . Gawande, A. A. (2009). A
surgical safety checklist to reduce
morbidity and mortality in a global
population. New England Journal of
Medicine, 360, 491–499.
106. Haugen, A. S., Softeland, E., Almeland,
S. K., Sevdalis, N., Vonen, B., Eide, G.
E., . . . Harthug, S. (2015). Effect of the
World Health Organization checklist on
patient outcomes: A stepped wedge
cluster randomized controlled trial.
Annals of Surgery, 261, 821–828.
107. Gawande, A. (2010). The checklist
manifesto: How to get things right.
New York, NY: Metropolitan Books.
108. Writing Group for the CHECKLIST-ICU
Investigators and the Brazilian
Research in Intensive Care Network
(BRICNet). (2016). Effect of a quality
improvement intervention with daily
round checklists, goal setting, and
clinician prompting on mortality of
critically ill patients: A randomized
clinical trial. JAMA, 315, 1480–1490.
109. Friedberg, M. W., Chen, P. G., Van
Busum, K. R., Aunon, F., Pham, C.,
Caloyeras, J. P., . . . Tutty, M. (2013).
Factors affecting physician professional
satisfaction and their implications
for patient care, health systems, and
health policy. Santa Monica, CA: RAND.
110. Stern, R. J., & Charlton, B. (2015).
Maximizing the EMR’s educational
potential. JAMA Internal Medicine, 175,
111. O’Kane, M., Freedman, D., & Zikmund-
Fisher, B. J. (2015). Can patients use
test results effectively if they have
direct access? The BMJ, 350, Article
112. McCullough, J. S., Parente, S. T., &
Town, R. (2016). Health information
technology and patient outcomes:
The role of information and labor
coordination. The RAND Journal of
Economics, 47, 207–236.
113. Handel, B., Hendel, I., Kolstad J. T., &
Whinston M. D. (n.d.). Information or
compensation? Understanding the role
of information technology in physician
response to pay-for-performance.
Unpublished manuscript.
114. Frosch, D. L., May, S. G., Rendle, K.
A., Tietbohl, C., & Elwyn, G. (2012).
Authoritarian physicians and patients’
fear of being labeled “difficult” among
key obstacles to shared decision
making. Health Affairs, 31, 1030–1038.
115. Fagerlin, A., Sepucha, K. R., Couper, M.
P., Levin, C. A., Singer, E., & Zikmund-
Fisher, B. J. (2010). Patients’ knowledge
about 9 common health conditions:
The DECISIONS survey. Medical
Decision Making, 30(5, Suppl.), 35–52.
116. Hoffman, R. M., Lewis, C. L., Pignone,
M. P., Couper, M. P., Barry, M. J.,
Elmore, J. G., . . . Zikmund-Fisher, B. J.
(2010). Decision-making processes for
breast, colorectal, and prostate cancer
screening: The DECISIONS survey.
Medical Decision Making, 30(5, Suppl.),
117. Sepucha, K. R., Fagerlin, A., Couper, M.
P., Levin, C. A., Singer, E., & Zikmund-
Fisher, B. J. (2010). How does feeling
informed relate to being informed?
The DECISIONS survey. Medical
Decision Making, 30(5, Suppl.), 77–84.
118. Brewer, N. T., Chapman, G. B.,
Schwartz, J., & Bergus, G. R. (2007).
Assimilation and contrast effects
in physician and patient treatment
choices. Medical Decision Making, 27,
119. Samper, L. A., & Schwartz, J. A. (2013).
Price inferences for sacred vs. secular
goods: Changing the price of medicine
influences perceived health risk.
Journal of Consumer Research, 39,
120. Blumenthal-Barby, J., & Krieger, H.
(2015). Cognitive biases and heuristics
in medical decision making: A critical
review using a systematic search
strategy. Medical Decision Making, 35,
121. Friedberg, M. W., Van Busum, K.,
Wexler, R., Bowen, M., & Schneider, E.
C. (2013). A demonstration of shared
decision making in primary care
highlights barriers to adoption and
potential remedies. Health Affairs, 32,
122. Blumenthal-Barby, J. S. (2017). “That’s
the doctor’s job”: Overcoming patient
reluctance to be involved in medical
decision making. Patient Education &
Counseling, 100, 14–17.
123. Stacey, D., Légaré, F., Col, N. F.,
Bennett, C. L., Barry, M. J., Eden, K.
B., . . . Wu, J. H. C. (2014). Decision
aids for people facing health
treatment or screening decisions.
Cochrane Database of Systematic
Reviews, 2014(1), Article CD001431.
124. Cosgrove, D. M., Fisher, M., Gabow,
P., Gottlieb, G., Halvorson, G. C.,
James, B. C., . . . Steele, G. D. (2013).
Ten strategies to lower costs, improve
quality, and engage patients: The view
from leading health system CEOs.
Health Affairs, 32, 321–327.
125. Cooper, C., Knoll, M., Sieminski,
D., & Zimmerman, D. (2016). Tools
for saving: Using prepaid accounts
to set aside funds. Retrieved from