« Freakonomics Radio

397. How to Save $32 Million in One Hour

2019-11-13 | 🔗

For nearly a decade, governments have been using behavioral nudges to solve problems — and the strategy is catching on in healthcare, firefighting, and policing. But is that thinking too small? Could nudging be used to fight income inequality and achieve world peace? Recorded live in London, with commentary from Andy Zaltzman (The Bugle).

This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
This podcast dynamically inserts audio advertisements of varying lengths for each download. As a result, the transcription time indexes may be inaccurate.
Friggin amongst radio sponsored by progressive insurance were customers, save an average of more than seven hundred fifty dollars when they switch in save visit, progressive dot com to get your car insurance quote, it only takes about seven, National annual average, auto insurance savings by new customers surveyed in twenty nineteen potential savings will very, if you'd like to listen to for economics, radio without ads the place to do that is sticker premium five dollars and you can get a free month trial by going to stick your premium dot com and use a promo code freak. You also get access to all our bonus. Episodes and you'll be supporting our show to that sticker premium. Dot, com, promo code, freak thanks.
here. There is, even though we recently visited London and recorded to live shows there. You ve already heard the first featured London Mare city com and the directive, research for Liverpool Football Club, the champions of Europe here now is the second of those shows which is an entirely different animal. It was held at the key to this. From centre just across away from the houses of parliament which, during our it would consumed by bricks. It protests the terms and walk out our gathering I have been more cordial we also learned a great deal about behavioral science and, what's called been nudge movement, hope you enjoy
Ladies and gentlemen, we welcome the post freaking out radio, Stephen, thank you so much and welcome to this special episode of Economics, radio. We were according lived night in London, where nearly ten, years, go a quiet revolution began. It was headquarters at the very center of the Uk Central government and promoted something that you wouldn't think would necessarily need promoting, which was government policy make based on actual empirical evidence when it makes sense for governments to design policy based on such research rather than on
opinion polls or personal win or worse yet the highest bidder. This was the revolutionary idea behind the establishment in two thousand and ten of the behavioral insights team or as its more commonly called sometime with affection, sometimes ridicule the nudge unit. There, mission was to translate social science research into simple and inexpensive policy ideas that would help collect taxes more efficiently, get the unemployed back to work faster, perhaps even increase happiness and well being, and so tonight we have come to the epicenter of this revolution to learn its history, its progress and failure, and its future. Now we should say the nudge movement has not been without its critics. It's been accused of overreach of arrogance of naive, the entire enterprise.
All for a certain amount of scepticism, and so we have asked to join us tonight. A professional sceptic he's also host of the bugle podcast and a professional cricket commentator. Would you please the great Andy results. Men. Have you give me thoughts on this nudge movement, Slash revolution, so around and economics vanilla, sincerely By doing that way, I consider that life very well lived. If I get the etymology still unable to understand this mysterious, which fundamentally witchcraft and a pinstripes economics, is the art of telling people actually what's gonna happen and then explaining. Why didn't you anyway? Notch theory was developed, of course, by the map. One of the world's most enduringly successful franchises. Now lodging had a resurgence? Software scheme that put pictures of insects in your rifles in a dutch airports, because men a notoriously easily
strategy does a species and it was found. giving them a target to aim at this provided a little. Incentive to stop sprang the entire room with unstoppable jets of was so highly successful. There's all about gentle products to change behaviour, Rawdon extreme right, because one of the floors, and also as a species, that human rights that we don't really care about massive existential threats with the big knowledge of increasing prospect of a relatively eminence in high grade Armageddon. Doesnt seem too out of aging and offers a species is too big and it's too vague go back to your small analogies, might work, maybe or plastic bag should be forced to be shaped like a dolphin must make us think. I'm ok, Maybe cabin crew and short haul flights should be penguins trains. Does I very too late. I'm afraid we have run out of ice,
in results. Men. Your perspective is most appreciated. Let's hear now what the actual nudge practitioners have to say. Our first guess tonight is a psychologist. political scientist by training whose career is tackled between government service and academia. It was he who launched the nudge unit undercut servant of Party Prime Minister David Cameron years early He worked in the Prime minister's strategy, even under Labour Party P M Tony Blair. Would you please welcome the chief executive of the behavioral insights team? David helper to David. As I understand it, you created that knowledge. with a two year sunset clause. In case it wasn't working at the beginning. What probability would you have assigned to the likelihood that it would turn out,
way it actually has. I think so you no more than fifty fifty. That was why we set it up with a sunset clause: governments across the world, full of units of people. That seems a good idea and they never get round the shutting down. Because history a lot of common policy. You things up, we don't know where they work to carry on doing them. Nonetheless, so of all the projects that b, I t the behavioral insights team has ruled out. guarding energy savings and tax compliance. In August, the biggest one is using automatic enrollment to increase pension savings. If could put a number on it. What would you, is the median rate of improvement overall. So one of the key points is most things: don't work and thus actually quite difficult truth for people to come to terms this probably half a dozen which a sort of billion dollar impact plus and then you go quite a lot of things which are quite small impacts, are not done name, a billion plus project who is tat it would be things like. Pensions is a famous one. Getting pay with Paypal,
tax on time, not vary widely used replicated across the world less one. Interventions on cigarettes, we think, is definitely billion dollar glass in terms of its impact so ease cigarette in the states, says I'm guessing you know well, are going towards the direction of what looks like it may be, not a total ban, but very, very significant regulation. Can you tell the story of E cigarettes here so we took a view back in two thousand and eleven when the first reaction and beloved folks in health community was, we should ban these things and we felt on the basis of an addictive, maybe a u turn introduce a substitute, is likely to be pretty effective. Now is very controversial the time the more recent reviews by public health. England, S made the circuit forty thousand extra smokers a year quit tonight's, absolutely enormous, absolutely enormous affects eyes. He I eat if you discount, in the future, that is easily a billion dollars a year impact, there's a lot of advocacy against. What's called harm reduction
people. Dont want to introduce something, that's half step, so in this case the use of nicotine, but not delivered through a cigarette. Who were the biggest rivals of this does that ISA grids be allowed. Here was a whole industry. Member understandably spend thirty years working games, tobacco And then someone comes along with a thing that looks a lot like a cigarette. You can understand that suspicion, so you're a whole set of institutional and professional first things which are against now. The U S is moving, probably toward much stricter regulation than here. Have you had conversations with public health officials there? What would you say to them to suggest that per Apps url is long term. but better out here will we do take the view that we should regulate them so, for example, we really didn't want insult the kids. We didn't want it to recruit new folks there regulations around. Are they safely? Will they literally blow up regulations? Around since there are equal of regulations. There is not that we didn't have it regulates, and if that was one of the key points, that it really mean
They do deliver enough nicotine to actually be effective. Remains, as happens in open issue, because the regulation stops the level of strength is this not regulated Let me interrupt alive, schoeffer, second, to say that these cigarettes in the UK have been handled so differently than in the. U S where, as you ve likely heard, there have been more than thirty deaths and many serious injuries from vaping episode next week will be devoted to this issue, because if you ve only been reading the headlines about weeping in the- U S, then you're missing out on lot. The story, ok to our interview with the founder of the behavioral insights team, David helper. So let's talk about the tax revenues produced by better letter. Writing walkest you're. What was the problem? What were the proposed and trials solutions and what turned out to be most effective? So if you think about it, most revenue service? Is there in the business of trying to get people to something which they may or may not be super happy to do, which is to say that
On the other hand, you don't need. I want to pay your neighbors taxes if they're not, but please this. In the unlikely event, you will like paying your tax theo, get letter saying income on and they will send the site. letter to everyone which is some form of threat or whatever then famously the early trial was. Why are we just tell people something which is true, which is most people, pay their tax on time? and adding that one line, nine or ten people pay their tax on time. Would that lead to people? and just paying out without further prompt when that further action- and the answer is yes, it did, and indeed tried, multiple variations back then that was unbelief the very controversial. I just can't tell you how, because it, why was when it was felt, listen reasons why you know what you are stocks. fermenting on people and the system was built to do it very questionable Would you analyze it Andy? Vaults. Men have you, forgotten one of these lovely tax letters, but not glove noticed, but it often open. I post tax, is essentially the region
a form of crowd funding. We ve got a bad reputation over the years, really what needs to be done more positively. but do it like an appeal? Look at almost like a chair to get a leaflet saying goes on you chemistry lab in your local school night, us basically, what tax isn't it Oreo get daydream new hip, I'm just saying you ve gotta, pay your tax and make it more powers, and also, let's have some gratitude. Let's have a nice. Thank you letter Day, Mr Ullmann. Thank you. very much for your tax people having so generous this year, not tell you what they spend on what you may be joking, but I think hard plays ideas at least a word testing we can build a better world. There is some evidence giving people some say: going to pay your tax on, say no to the nuclear warheads palazzo I'll say. There was a marginal extra pound or dollar. What would you prioritize? The few people do the about it and one of the quantity questions even burden eyes, do feel quite good when they
money to charter is right. In fact, does you'll know debate a little better than they think that deal I know when they pay the taxes, when you feel good, that goes to boarding schools and hospitals, and so on. So one of your checks or so tax authority. In my do you should not eat revenue, but, as you have, people feel ok about it or not. It's lovely to hear about all these successes in I would like to hear a spectacular failure? Please, you wanna hear some of the things that didn't work, all of them to images of homes showing infrared immature, showing how much heat their losing I'm. Putting their own request to get your home insulated turns out to make people significantly less clean together home insulated. There was good luck. Yes, it was a good idea. You know they list People get all that looks, walnuts, cosy, I'll, keep getting people who go to major airport to switch to public transport. Really big effort did absolutely ITALY's work.
Grit grit base intervention will number interventions with sixteen seventeen year olds somewhat incredibly, but we found the girl base intervention, at least in the UK. It did increase attendants rights, but it didn't increase the pass rights one was getting- manages to be more sympathetic towards basically senior female staff, a long time. We love academics, designing this perfect intervention exact reversed. getting male manages to be attentive and this particular way you know there she were less. Ultimately something did it produced a bunch of sexual harassment lawsuits in the process of opium work, but it does not have the exemptions that they are much less member, we're gonna. Logically or you don't remember all the terrible recipes for food that didn't work right. You want to lose them. You remember the ones who did work, but actually for this field. It is important is choir, big lesson and quite serious point. Here we work with a lotta governments loved parliament's across the world. Everybody wants
celebrate and talk about the examples that work. The fact is, you should expect Georgia things you try if their innovative and quirky will not work right as really important, and how do we get an information circulating? We need to be open about that, and actually we need that list We need that list available so that we don't keep doing other things are repeating them very good, we'd like to bring you back to the end of the showed to talk about the future of nudging. Let's say goodbye for now, ladies and gentlemen, that was David. How it is time now to hear from some people who ve been putting these nudging policies into practice along the behavioral science. Research we ve talked about on earlier shows is about improve long term, health and welfare as individuals and society. Tonight, we're going to focus on some more immediate high stakes scenarios.
Not typically associate with nudging, specifically medical care policing in fire fighting, so our next guest is chief fire officer of West Sussex, fire and rescue services. She also holds a phd in psychology and she's. The author of a book called the heat of the moment, life and death decision making from, your fighter. Please welcome Sabrina Cohen Hatton revenue to be here. Frankie, so fire fighting wouldn't seem at least to me to be an area where behavioral science would have much to say- or maybe this failure of my imagination so tell me where I'm wrong him and the kind of work is done now. You are wrong. It is exactly the place of behavioral science site. I've done a lot of research over the last decade. Looking
How incident commanders make decisions in very high pressure, high stakes, situations on the reason for that is is a huge amount of the fire fighter, injuries that we have a caused by human error. Eighty percent of accidents across industries by the way, not just fire, a caused by human error, not a problem with a piece of equipment, not a problem with a policy or procedure but one mistake: the wrong choice in the wrong place at the wrong time. When you talk about bad decision making under stressful environments. Like that, I'm curious to know whether the primary driver is the uncertainty of what may happen or the physical pressure of time endanger, was depends how you quantify bad, because sometimes you can make the best decision, but the outcome still gonna be a terrible one on one of the things that we find in the fire service is something
decision, a national. You are paralyzed by all of these thoughts about what could happen in the room, cushions and the accountability on yourself I'm situations you literally have to choose the least worst option, so we ve developed some technics court decision controls. Essentially, what we wanted was for them to give you back control andean There is to know how you feel about having something called a decision control it to your own daily work. I think I can very much do with it. I get decision inertia in restaurants and so the decision control process is essentially a rapid mental check. What command ask themselves? Why am I doing as well? my go? How does this link up with one Trying to achieve that then asked himself What do I expect to happen and then, finally, how does the benefit justify the risk?
when commanders were using this process. We measured the latency between the time it took to make a decision and action at There was no increase, so didn't so down decisionmaking, so that was really good, but we also found was it increased? Their love the situation of the wine is quite significantly, and how is the training done then is a classroom. Training is a simulation of a fire, a bit of everything. Actually, they obviously need some first of all in a classroom, but you need to be able to use it practically. So a lot of the work, but we do a simulation based on two may: more realistic. We get derelict buildings and before they knocked down, we just to fight it, yeah, for I could see you are living that larger, maybe with thousands of parliament, is basically derelict having a go at that has year reach. lead to changes in policy cross country and what is the evidence that its successful and Anne had you seek out that evidence? So we
These techniques and we tested them in a range of context, so we were using virtual reality, then we repeated the same. on a training ground and then burning buildings down and testing at an environment and one we analyzed. The data so it's. What we found is that the common, does that we using that process was significantly more called erected, which was great but you're, not gonna collect everything serving why, especially in that kind of dynamic risk environment, so we strapped dough programmers to come on this head. So we record all of that information, all of that data and critically what we got from that is the information that they didn't attend to as well. What they did you have them watch the tape later and yet how you what they were thinking in what they? Actually yes, so we develop something called a key recall deprave, where we essentially were playing back the veto. to them, which provided a cue to recall that memory and got them to talk us through their thought process at the specific point,
I'm precisely in relation to what they were saying. Can you give an example of a resulting action, then that would have been better than before, so what we found. The initial research is that eighty percent of it the decisions that were made very intuitive so, for example, I'm going to put water or not fire perfect reasonable? You say- and you do, but actually, if you're putting me on that, I bet you haven't joined up for the rest of the information that you ve got about what some fire, which might be oil or petrol. My will does not actually gonna help you in that circumstance then you're gonna, for the wrong outcome. You respond to a lot of things these days. It are not fires. Correct I mean have on your calls. What share of those are actually fight Actually, the number five that we go to has reduced over time and we go to a much broader range of incidents, but Similarly, the number of incidents that way those who rule has reduced in the last ten years by about fifty percent, and we do a lot more preventative work there,
some changes in legislation which of assisted, but what that means for Firefox you're going out of business well know because as always the risk, and we have the results, are fire services to risk not to demand, but for fire fighters, it means you're. Having less experience of the kind of things you are expected to deal with, so we ve gotta be much. all now, making short We train in a realistic way, so people don't just have the skills, but they have the confidence to deal with those situate. the Green, a hadn't come and thank you so much for joining us tonight. Our next guest has been a policeman for more than twenty years. He holds a masters degree in criminology from Cambridge. Ten years ago he started the society of evidenced based policing, which now is three thousand members around the world he spent most of his career with the West Midlands police, but
recently became commander for specialist crime with the metropolitan police here in London to please welcome, let's Murray, Alex Great to have you here so the Metropole, please is essentially the London equivalent of a New York Police Department. Yes, absolutely thirty thousand offices, ten thousand staff sipping outfit and guessing that policing is full of conventional wisdom. That is not, in fact, very wise. Is that a correct assumption is a very fine. Miss criminologist, who can peas, who says you can have a career in policing? We can have a year in policing just lived over and over and over again and see you off I've done one year in the front line and then come out they still refer back to their first six weeks when they came out of college so from an evidence base,
this point of view we try and make the evidence of war is effective. With that really good experience the people have put together now, when I think of again kind of like with firefighting, when I think of behavioral science and policing, I really can't conjure up many images for how works. Do you run randomize controlled trials? What do you do? We won the minimalist control transfusion Llosa things more. Things are a lot of things just on effective and we gotta work out, particularly in Austria time what is effective and what is it I give us an example of a success and how it came about ok, so of the whole Point of policing is about changing behaviour. So how do you stop people come in climate? So, if you are subject to a burglary, sadly your increased risk,
of being subject to a burglary again and in the very near future, monotony that your neighbours, our and your neighbors neighbours up to four hundred yards either side of the house, the reason being simply that I worked once and it will work again or as area. So, if you have a burglar, you go when it work. Last time I'll go back on how the house's set up. I wasn't court last time. You know this sort of logic there. So a big city in the UK, we split the city in political boundaries into as they were much don't social demographic basis and in each pair one sort of how to treatment one had control and in the treatment area. If you were one of those houses that was a high risk, a burglary or new, he beggary. Are you a neighbor within twenty four? as we said enough surround who had a big stick riven and they stuck on the dole and now nation is a dog ass, a big german shepherd dog. So, if any Bergen, it looks at my window. Doesn't when there's a dog in there, I could have a dog shaped sticker without an actual dog inside the correct. Yet obsolete
windows. They had some like window alarms and things like that in the control area, single business as usual, policing and people could use them initiative that you know the police, officer in charge of the Erika do what they want. We call it target hardening is, is not unique and we tested to survive ability of those houses. So over a period of time, one hundred days, what was the chance of them being leave it to my compared to the control and had to do from a metric point of view, there was less repeat victimization in the test area compared to the control area in Austria, the lower crime areas. We did see statistically significant reductions in repeat offending repeat victims, Andy when you burgle home, do tip we return to the same home or neighbourhood or move on supposed Busby all special sacred leaving no when I break into people's homes, are allowed to do something positive about to leave something there, rather than take something believer in the nice antique or a bottle of Cordillera jar, pickled onions, this scattered passivity back into crime,
Alex. I understand you ran another experiment having to do with collecting money from speeding tickets. Yet in the UK you gets a speeding, finds normally from automatic cameras, sport, you and they send you away. and he says what you to present jogging this car and you can then elect, have points in your license or go to a driver improvement course. Now get one and I have to confess I've had won an enemy. It's in in these were legal jogging ease, probably fulfilling all requirements in the target missing. The point policing is full of police officers and quite lawyers, and we speak and we write in a certain fashion. We don't have this concept to persons and design and we experimented where, for one week we sent a letter for the next week. We send out a difference letter and that letter was a picture of a lamp post with some Teddy bears around it and data on the amount of children killed by speeding motorists in the area.
sweet back to normal IDA next week back to that lead, and we did that on your phone and often on and off, and that sort of experiment is being replicated around the world because it's really a potent so, but you didn't tell us, did the teddy? airs work. Did the shrine to accident victims increase payment? We work if you that data the moment it's replicated here in London, we didn't find any statistically significant results. So, as we speak We got unless like working through the data. There was a research project that I believe you were behind, having to do with a message is being written on a jail cell wall. That was you correct. Yet it's my favorite expert, all times. So if you go into a police cell in the UK, I don't owe you probably both experienced it. Where were you sit and you look a blank wall for anything up to twenty four hours: There might be a stencil in the wall says if you want to get off drugs find this number, but pretty much nothing happens. So we thought well captive audience
but lady graffiti on loads of cell- and this was growth mindset graffiti positive messaging purporting to be from an offender you sleeping in Ankara feet on the wall, so things like next time, try to burglah home in a different neighborhood. You want me to just some of the graffiti loving people, think What they do makes them, who they are it doesn't we already stuff, because we got angry because we felt good or we didn't think I was but you gotta blaming others. But when I was here, I realise it is time you some What I do is my choice and I chose something else when I left. I do things differently it took effort, I won't lie, but it paid off. Think was the one thing you can do to make sure you. Don't end up back here, remember when the door opens do it is never too late now, just to be clear. These are fake sentiments, correct note We actually spoke to and reform defender, and we very much go to the principal from him, so that was real integrity in it, and then we stuck it on the walls. Now we know of this research because it was feet.
Several years ago in African Alex Radio episode, it sounded like a brilliant idea. How well did it work so when we looked older, people had been through all the cells with the graffiti and all the people who ve been through the cells without the graffiti, and had no effect whatsoever. So. I certain we didn't jinx it. Why do you think it didn't work when you had such strong expectations? it might be that we got the messaging long. It might be that being a growth. My so we'll just doesn't work, I'm not weapon Someone else is going to replicate it with different messages that will see as an effect Alex
free of the metropolitan police thanks so much for joining us tonight. It is time now for a quick break. Remember you can listen to Freakonomics radio on any podcast app and you can get the entire archive on the Stitcher app word: freakonomics dot com, or we also publish transcripts and show notes. So, if there's anything you're hearing in this show- and you want to learn more about- go to freakonomics dot com, we will be right back freedoms, radio sponsored by Petsmart Petsmart makes it safe and easy for you to care for your pet at Petsmart, the health and safety of employees, pet parents and pets are which most important, which is why they require face coverings social distancing and stop plexiglas shields and enhanced cleaning to follow CDC recommendations for contact with him. Thing just order online at Petsmart, not com or on the Petsmart app
joy, easy curbside, pick up for same day, delivery powered by door dash free through January thirty. First, two thousand twenty one check out: Petsmart dot com for more details, Fr Economics, radio sponsored by capital one with no he's or minimums on checking and savings accounts banking with capital One is the easiest decision in the history of decisions like, choosing to listen to another episode of your favorite podcast and, with their top rated app you can deposit, transfer money anytime anywhere making capital one. And even easier decision. That's banking re imagine What's in your wallet terms, apply capital, one a member. If the icy This episode of requirements, radio was recorded, live in London, where We attended a conference organised by the behavioral insights team, also known
as the nudge unit it. was originally established within the british federal government with the goal of applying the hate science research to policy, making many minced around the world have since copied this model, as have other institutions, as you're about to hear our next guess is a physician as well as a professor medicine and health care management at the University of Pennsylvania he's also, the director of the pen, medicine nudge unit, he's done these studies and interventions round patient compliance, physician behaviour and system, operations in healthcare? You please welcome meets Ashputtel meaning nice to see you thanks for having Our common is a nudge unit inside a hospital system. Now a common yet, but we have to change that. We are the first. We were there,
First, a behavioral design team embedded within the operations of the health system in the world? No offense, my experience, doctors in particular, are not very fond of being told how to do what they do. I'm really curious how you pulled it off the kind of strategically yeah, I was a significant challenge. You know. Many doctors, including myself, have been through a decade of training and medicine has become more specialised, and so people are experts in their fields, and so I think there are two key things that help is to reveal the clinicians that they themselves are being knowledge in there. Just not even aware of it. The design of the electronic health, It is pushing you in sometimes you're, taking a lot of extra steps to do that and other is to engage them without away he started off our Nigeria was actually to host a crowd sourcing challenge where clinicians and other stakeholders could submit ideas, and we actually got two hundred and twenty five ideas and two weeks. Inclination so very quick run down, will drill down of some of the interventions you ve done when you are one of the first things that priests,
He did the Nigerian. It was actually the impetus for building. It was changing generic prescribing rates and we were able to move the neo significantly from seventy five percent to ninety eight percent, almost overnight, just by switching the default. What happened was there oh gaiety person was implementing something else around prescribing and actually noticed since then, I'm just gonna put a check box here and if they dont check the box, the prescriptions gonna go to the pharmacy as generic and the next week, or so. The whole system got a phone call from our largest ensure and said you just went from last place too. this place and generic prescribing instead of penalizing you we're gonna, give you a bonus, and the first thing everyone's that, as this is not possible, we ve been last for years, and then we realise what had happened, one hour of work resulting thirty two million dollars of savings in the course unbelievable. So if there is that much money to be so it's so easily. Why hadn't? This been done before worse and other countries around the world. The way that doctors make decisions changed in the last decade it used to be all of this was done on prescription pads and over the phone
So we didn't have insight into what was going on. Nor could we change it. But now ninety percent of doctors use electronic health records, and so most of the effort has been to get the electronic health records system set up to get doctors, you lemon. There hasn't been much testing, so there are lots of good ideas that are locked into one department or one hospital and don't get spread to other places, and there that's a bad ideas that are implemented and never taken away, and so our approaches to take a systematic way and test these so we can scale the ones that work and turn off the ones. I don't. I understand you also changed fault on the number of opium aids that are typically issued after surgery would say: yes, yes You come into the emergency apartment and you have an angle sprain or you just gotta tooth pulled another injury, there's good evidence the show, the larger the amount of pills you get, the more likely you're gonna be addicted, and so we found out just by changing the default from thirty pills to ten pills, cut, unnecessary opiate prescribing can.
And did you find that ten is actually an optimal number should perhaps be even lower? Do no to their actually guidelines around this debt to recommend that you should get three to five days of opiates, which is about ten pills, but the great thing about using defaults. It doesnt force you to make a decision. Clinicians can override their meet us. I undressed There is also an intervention you ve done on cardiac after care, yet Let's say I come in, I have a heart attack, I'm treated I'm alive and relatively well. I leave the hospital then what happens? Typically, so typically one's own comes in and has a heart attack. We know that exercise is good for them. There is actually a structured program called cardiac rehabilitation or cardiac rehab. It's twelve. We program. You go in for two three or more. sessions and you do exercising get advice from a cardiologist, it's like having a frija membership with a cardiologist available for consultation, theirs actually no harm to everyone should get. It are cardiac wherefore. It was fifteen percent, meaning a hundred patients come in to the hospital each week with a heart attack.
eighty five of them go out the door, never even told that this exists, let alone that insurance covers it, and so we worked M to redesign this and force we had What the problem wasn't me what we found out. It was a manual process and the burden was put on the cardiologist on a bit. Near browns, they had identified, who is eligible for Karnak Rehab and felt a form with fifteen different fields: name date of birth, a record number things that already exist in the electronic health record. So we spent some time talking to cardiologists and testing things for three months What we did is we use electronic health record to automatically identify patients who had a heart attack turns out that's easy. They had a stent placed rather uncertain medications. We notify other care members the clinician on rounds and when they arrived at that patients room this form is automatically signed and them close the loop with the patient, which had never been done before, still dealing with the fact that they have to want to participate in that physical activity. Do you have any nudges to help with that? Yes,
this alone, just referring them, increase their referral re from fifteen percent to eighty five percent and the attendants rate from thirty three percent to fifty five percent so huge left there we have a bunch of pensions around getting people to be more physically active and actually testing them in combination with these were fro patterns. recently. We were working on game affiliation and found that increase physical activity. You can take it further moves in the NFL basically damages people's health. You can set up a little turning to improves people healthy. Other national cards recovery League and have a draft and all the teams genocide a list, patience and things there can be no new next break through sport. For America like where you're going to have to test at an indifferent settings and see our except one problem that the medical, please come to recognise lately or knowledge is the issue of too much medical care in the form of tests and procedures and end medications. Are you do anything about that. Yes, we have agreed,
example from palliative cancer patients? These are patients who are at the end of life. They have days two weeks left to live and often times they can get radiation therapy to shrink the tumor. Sometimes it's pinching on a nerve other times. It's an uncomfortable place and radiation therapy can make the end of their lives easier in order to make sure that the radiation hits the tumor correctly will often do. City scans are actually now when we know we're gonna cure the patient, we're trying to cure the patient. just go live many years and we need to do an x ray cities can possibly every day because we don't hit normal healthy tissue. But there's a lot of evidence. Even national guidelines sing at the end of life, we shouldn't be exposing patients to unnecessary imaging a cost. A lot of money and it doesnt led to any benefit because the patients are gonna die in a few weeks or months. What we found it. Our health system is. Seventy percent of these patients at the of life were getting daily imaging meaning if you have fourteen doses of radiation, you got fourteen x rays or city scans and oftentimes insurances were no longer covering this and they may get hit with some of the bell for that so
instead as medical history, is full of stories about successful treatments being discovered with straw. evidence and then not enacted for months years decades, and I'm curious what the rate of adoption is like for these interventions, that, to me sound, sensible, doable, cheap, executive, ble, etc are hospitals around the can three rushing to, if not emulate you by setting up their own nudge units at least reading these papers, in trying to do things like switch defaults for generics and so on, you who is to hopefully spread this around the country and so we're doing two things to really scale this week, as we host in annual nudges and healthcare symposium, bringing together health systems across the world to want to implement nudges are not units and the second we have launched a nudge collaborative it's an ip platform where people can sharing sites from what worked in what hasn't? We worked out more than fifty projects. Now bunch of successes, but also failures, and we don't want those to be replicated. We want the good ones to be
get it, but it also provides a management tool. We learned a lot from how we manage all the crowd sourcing, ideas that come in and what moves form. What doesn't, and this is far from their will and health systems who want to do this, do it by hitting the ground running. I play. I'm so glad you're out there doing this work. It gives me hope and its exciting. Thank you. So much for joining us tonight, Patel now before you finish? If he hasn't run off I'd like to bring back Roger in Chief David helper of the Behavioral insights team David. So David We ve heard about a lot of successful nudges tonight. Some failures as well, but I ve got to say many of them seem in retrospect, quite simple, even predictable, at least after, acted sort of low hanging fruit and I'm We have to know if you have larger aspirations
maybe to consider how behavioral science can address core economic issues, income, inequality and market failures or like social mobility. Do you think about how to? than others the people in position to make bigger, broader applications? Oh yes, I think jewellers things on economic policy. especially in one of the deep ironies of behave economics, hasn't been applied. Much to economics might lead market where you actually knew where there is a really good place to work, not just what you'll be pay? but you know how good is the boss, put your progression opportunities in so on most individual applying. They don't know the answer to those questions and then a classical. LISA resuming the work is well, so We think there are lots of issues like that where the economy doesnt work and there it takes you to Edna of policy tools. How can you help She make us see their own failures Paypal, we call it
often the most senior become the more over confident you become and weave on? Fellas should be policy in your book in at a nudge unit. You mentioned a few ideas that fell on political grounds. One of these concerns illegal immigration, as you put it breaking the implicit collude, in between rogue employers and illegal employees. Can you tell us a bit about that idea? Yeah, come up in a number of countries, not only in the UK, where you get She quite nasty abusive practices, you if you're in employers posted a load of checks, the information often should exist, but When someone they have US school national insurance number be similar many countries. Why can easy and and We do check for the employer, so we were, doing there an do. We will otherwise is quite a nasty cycle if you think about it, because in get someone who had. She doesn't right who they are then quite abused in the labour market. So how do you break out that? So, yes, we suddenly looked to summarize policy issues so considering them,
immigration policy was a strong driver of bricks. It ideology. I am curious David if you stay up nights. king about what might have been had those in ideas of Europe has been given a shop things you answer your love, others he's going around breaks, it might be. There are some quite profound issues about what makes a nation hold together in relation to its cohesion. How do you feel your sentiment towards you a fellow citizen and beyond the immediate data day of it. That is quite a consequential thing, There's a topic you written about in the past social trust does nudge dear. If we want to call it that, is it able to be successfully applied to building social trust, you think there's one of the great in fact, one of the big political areas in the early days of the time as team was being created, was then known as then known How do you stimulate? How do you build a century's social capital, social support?
fell by the wayside on the politics for various reasons, but the fun mantles other remain absolutely key. So, yes, we take the simple trust, questioned other people can be trusted is a better predicted. actually growth rates, that levels of human capital phenomenally important? How you feel about your fellow citizen so you know beyond the shouting and that the German was happening in parliament. Do you look? I showed you don't trust your neighbour, but do you feel that you ve got tools in your arsenal that have been earned over the last ten years. It can apply to this. Let me know, intervention we done willing to itself a programme which is good national citizens service to give young people a brief experience of volunteering community service loosely based on american type thing. but within it we did intervention, testing, different, icebreakers. One of the nice results is essentially getting young people to talk about. In what way are we similar, because it's designed to mix p from different he no social by
doesn't really seem to move the doll in relation to argue for more middle class backgrounds, but the kids who come from quite often disadvantaged backgrounds who the life experience may well be that she could contrast people quite often that turns out to be the iceberg get helps to move social transposing area. We definitely very active on what else you do in order to build that connection an exam, in the UK and public in the? U S, people go to university and job disadvantages. In this way they are more important things it'll, be they end up with much much more social trust in social capital. One of the factors is that you go away to university She kind of matters at you, you break your social bonds from home and you mixed with a whole lot of other people different background and you generally are able to trust. You learn the habits of trust, which you don't carry for a lifetime. The eastern into mental thing, but is it so important to society matters? We also try to look at issues around conflict where she is
They look more on that where you get, if we did ending up ten. She a war or the recognition of combat while it is important, that human behaviour is not just about whether you pay taxes on time, important ideas, but will you gonna, kill your neighbor. You know these. These really matter too, no to war start a year. Typically, why can't, Use the same kinds of approaches, C. Can you make it less likely that will reignite in the future? You occur in the first place, I think that's brilliant point and probably a great spot. To conclude, love to check back in with you all in a year, three I am assuming you still have a gun. and a sovereign nation of any sort in the meantime, thanks to you, David Halpern, fair appearing on our show tonight, thanks also to meet Us Patel, Alex Murray and Sabrina Cohen Hatton, to the inimitable, Andy exults men and thanks especially to all of you for listening this
beak and every week to free economics, radio good night coming up next time on for economics, radio, as per must earlier. In this episode, we will look at the: U S reaping craze, which now and not known about e cigarettes, the toxicological profile of these products indicates there much much safer then your at so why have people been dying from Beijing? Approximately eighty nine percent of the cases tribute of all to tee or black market vapor oils So is this an argument for better regulation of cigarettes or, as many places are doing, prohibitions dial ban? I think that the less We need to learn. Is that you do succeed when you have a popular products by banning it its next time on friggin amongst radio
Fr Economics, radio is produced by stature and w productions. This episode was produced by met Hickey with lots of help from ours in Craig Low Gregg, Ribbon, Harry Huggins and Stephanie Tam. Special thanks also to keep King Jason Ehler, Ed flock of in Lauren Gates and Chris right from the behavioral insights team, our staff, all Zack, Levinsky, Cornwallis indefinite check, our inter is Ben Shenkman. Our theme song is MR fortune by the hitchhiker's. This live version was performed by Luis Guerra and the Freakonomics radio orchestra. All the other music was composed by the least you can subscribe to Freakonomics radio on Apple podcast, her any podcast, app or entire archive can be found exclusively on the stitcher app or at freakonomics dot com, where we also publish, show, notes and transcripts to get our entire archive without a along with bonus. Episodes go to stick your premium dot com, slash economics. We also published every week on medium short text. Version of our new episode go to medium
come slash for economics, radio. We can also be found on Twitter, Facebook, then or via email at radio, at for economics that come our shores please on most of your better and pr station, so check your local station for details, as always thanks for listen teacher.
Transcript generated on 2021-01-18.