De overheid als keuzearchitect? - Wetenschappelijke Raad voor het ...

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public policy nudges: the government as choice architect we all have more willpower in the future than right now. Now many of us in the room are planning to start diets on January 2; not tonight, not even at the coffee break. So we invited people to join up for a plan where their contributions to the pension plan go up every time they get a raise, and this happens automatically. And it keeps happening until they say ‘stop’, or until they hit some maximum. Now the first company that we did this, we tripled saving rates and it is now available in thousands of firms around the us. It is sort of spreading like those flies. Now here are some examples of this principle in the health care domain. You know when you go to fill your car up if you have a diesel car, the nozzle is a different size to prevent you from putting the wrong fuel into your car. It used to be that there was a big problem in operations that people would get the wrong anesthesia. There is a machine with a lot of hoses and if you connect the wrong hose to the wrong slot, the patient dies. They solved that problem by making the nozzles incompatible, so it is just not possible to make that mistake. Another big problem in health care is compliance. There are many diseases where we know the medicine, we know the method to treat someone, but patients just don’t do what they are supposed to do. Diabetes is the classic example. For all kinds of things getting people to take their medicine is a problem. Think about the choice architecture of designing a pill. Suppose you want to manipulate the frequency in which people take the pill. The best kind of pill is the one you take every morning. The best would be a shot you get once and you are done. Now there is no compliance. Otherwise the best is once per day. Twice a day is bad, three times a day is terrible, but once every other day is completely hopeless. Is there any human that could master taking a pill every other day? Or every third day? That would be completely terrible. Once a week is not so bad. Some calcium supplements are based on once a week. Most people take it every Sunday morning; that is not too bad. Birth control pills are an interesting case, because you have to take them every morning and then you stop for a week. So the way they are devised is that there are placebos for 7 days, so you don’t lose the ritual of everyday. 17
de ov er heid a l s k eu z e a rchi t ec t One of the problems people have in hospit<strong>als</strong> is what is called the ‘central line infection’. When a central line is inserted, there are certain procedures that should be followed. If they are followed then everything is fine, but if they are not followed then there can be an infection. These infections kill people and cost tons of money. It has been shown that if they follow a simple checklist in the operating room, you can reduce these infection rates to zero. Interestingly, one of the items on the checklist is that nurses are given permission to remind the doctors to wash their hands. Hand washing is key. Covering up the body except for where the line is going in, is another key. Arming the nurses to remind the doctors to follow the rules, is one of the things on the checklist. There is no excuse for any hospital not to adopt these procedures, but many don’t. 18 Here is something that I have been pushing a lot since the book came out. It sounds quite boring but I think is actually quite important. The idea is to change the way we do disclosure. I still have to learn the way it works here, but in the us if I get a credit card, I get 30 pages of fine print telling me all the rules of that credit card, which I presume no one has ever read. Now what we are suggesting is to supplement that with an electronic disclosure. The way it would work is that once a year you would get an email with a file with two types of information. One is your usage data: it will tell how you have used that credit card for the last year. The other would be essentially a spreadsheet of all the ways that credit card can charge you for things. You could use this for credit cards, for mortgages, for cell phones – it is a perfectly general idea. Now it is not that we think any human would open those files. But we think that in one click they are able to upload the file to third-party websites, and that would help them shop and turn humans into econs as shoppers. When we wrote this book, these websites would emerge, they have already emerged. Here is another example. There is a website in the us that is called Billshrink.com. It helps people to find a good mobile calling plan. You could use the same system for credit cards. One of the principles that I stress is that we as consumers should have the right to our own usage data. The suppliers have it, they know how many calls we have made, how many text messages we have sent, how many emails.
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