Person: Madrian, Brigitte
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Madrian
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Brigitte
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Madrian, Brigitte
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Publication A Commitment Contract to Achieve Virologic Suppression in Poorly Adherent Patients with HIV/AIDS(Ovid Technologies (Wolters Kluwer Health), 2017) Alsan, Marcella; Beshears, John; Armstrong, Wendy S.; Choi, James J.; Madrian, Brigitte; Nguyen, Minh Ly T.; Del Rio, Carlos; Laibson, David; Marconi, Vincent C.Objective: Assess whether a commitment contract informed by behavioral economics leads to persistent virologic suppression among HIV-positive patients with poor antiretroviral therapy (ART) adherence. Design: Single-center pilot randomized clinical trial and a nonrandomized control group. Setting: Publicly funded HIV clinic in Atlanta, Georgia, USA. Intervention: The study involved three arms. First, participants in the provider visit incentive (PVI) arm received $30 after attending each scheduled provider visit. Second, participants in the incentive choice arm were given a choice between the above arrangement and a commitment contract that made the $30 payment conditional on both attending the provider visit and meeting an ART adherence threshold. Third, the passive control arm received routine care and no incentives. Participants: A total of 110 HIV-infected adults with a recent plasma HIV-1 viral load more than 200 copies/ml despite ART. The sample sizes of the three groups were as follows: PVI, n=21; incentive choice, n=19; and passive control, n=70. Main outcome measure: Virologic suppression (plasma HIV-1 viral load<=200 copies/ml) at the end of the incentive period and at an unanticipated postincentive study visit approximately three months later. Results: The odds of suppression were higher in the incentive choice arm than in the passive control arm at the postincentive visit (adjusted odds ratio 3.93, 95% confidence interval 1.19–13.04, P=0.025). The differences relative to the passive control arm at the end of the incentive period and relative to the PVI arm at both points in time were not statistically significant. Conclusion: Commitment contracts can improve ART adherence and virologic suppression.Publication Vaccination Rates are Associated With Functional Proximity But Not Base Proximity of Vaccination Clinics(Ovid Technologies (Wolters Kluwer Health), 2016) Beshears, John; Choi, James J.; Laibson, David; Madrian, Brigitte; Reynolds, Gwendolyn I.Background: Routine annual influenza vaccinations are recommended for persons 6 months of age and older, but less than half of US adults get vaccinated. Many employers offer employees free influenza vaccinations at workplace clinics, but even then take-up is low. Objective: To determine whether employees are significantly more likely to get vaccinated if they have a higher probability of walking by the clinic for reasons other than vaccination. Method: We obtained data from an employer with a free workplace influenza vaccination clinic. Using each employee’s building entry/exit swipe card data, we test whether functional proximity—the likelihood that the employee walks by the clinic for reasons other than vaccination—predicts whether the employee gets vaccinated at the clinic. We also test whether base proximity—the inverse of walking distance from the employee’s desk to the clinic—predicts vaccination probability. Participants: A total of 1801 employees of a health benefits administrator that held a free workplace influenza vaccination clinic. Results: A 2 SD increase in functional proximity is associated with a 6.4 percentage point increase in the probability of vaccination (total vaccination rate at company=40%), even though the average employee’s desk is only 166 meters from the clinic. Base proximity does not predict vaccination probability. Conclusions and Relevance: Minor changes in the environment can have substantial effects on the probability of vaccination. If these results generalize, health systems should emphasize functional proximity over base proximity when locating preventive health services.Publication Applying Insights from Behavioral Economics to Policy Design(Annual Reviews, 2014) Madrian, BrigitteThe premise of this article is that an understanding of psychology and other social science disciplines can inform the effectiveness of the economic tools traditionally deployed in carrying out the functions of government, which include remedying market failures, redistributing income, and collecting tax revenue. An understanding of psychology can also lead to the development of different policy tools that better motivate desired behavior change or that are more cost-effective than traditional policy tools. The article outlines a framework for thinking about the psychology of behavior change in the context ofmarket failures. It then describes the research on the effects of a variety of interventions rooted in an understanding of psychology that have policy-relevant applications. The article concludes by discussing how an understanding of psychology can also inform the use and design of traditional policy tools for behavior change, such as financial incentives.Publication What Goes Up Must Come Down? Experimental Evidence on Intuitive Forecasting(American Economic Association, 2013) Beshears, John; Choi, James J; Fuster, Andreas; Laibson, David; Madrian, BrigitteDo laboratory subjects correctly perceive the dynamics of a mean-reverting time series? In our experiment, subjects receive historical data and make forecasts at different horizons. The time series process that we use features short-run momentum and long-run partial mean reversion. Half of the subjects see a version of this process in which the momentum and partial mean reversion unfold over ten periods ("fast"), while the other subjects see a version with dynamics that unfold over 50 periods ("slow"). Typical subjects recognize most of the mean reversion of the fast process and none of the mean reversion of the slow process.Publication Testimonials Do Not Convert Patients from Brand to Generic Medication(Managed Care & Healthcare Communications, 2013) Beshears, John; Choi, James J.; Laibson, David; Madrian, Brigitte; Reynolds, GwendolynObjectives: To assess whether the addition of a peer testimonial to an informational mailing increases conversion rates from brand-name prescription medications to lower-cost therapeutic equivalents, and whether the testimonial’s efficacy increases when information is added about an affiliation the quoted individual shares with the recipient. Research Design and Methods: 5,498 union members were randomly assigned to receive one of three different informational letters: one without a testimonial (No Testimonial Group), one with a testimonial from a person whose shared union affiliation with the recipient was not disclosed (Unaffiliated Testimonial Group), and one with a testimonial from a person whose shared union affiliation with the recipient was disclosed (Affiliated Testimonial Group). Results: The conversion rate for the No Testimonial Group was 12.2%, which is higher than the Unaffiliated Testimonial Group rate of 11.3% and the Affiliated Testimonial Group rate of 11.7%. The differences between the groups are not statistically significant. Conclusions: Short peer testimonials do not increase the impact of a mailed communication on conversion rates to lower-cost, therapeutically equivalent medications, even when the testimonial is presented as coming from a more socially proximate peer.Publication Consumers’ Misunderstanding of Health Insurance(Elsevier BV, 2013) Loewenstein, George; Friedman, Joelle Y.; McGill, Barbara; Ahmad, Sarah; Linck, Suzanne; Sinkula, Stacey; Beshears, John; Choi, James J.; Kolstad, Jonathan; Laibson, David; Madrian, Brigitte; List, John A.; Volpp, Kevin G.We report results from two surveys of representative samples of Americans with private health insurance. The first examines how well Americans understand, and believe they understand, traditional health insurance coverage. The second examines whether those insured under a simplified all-copay insurance plan will be more likely to engage in cost-reducing behaviors relative to those insured under a traditional plan with deductibles and coinsurance, and measures consumer preferences between the two plans. The surveys provide strong evidence that consumers do not understand traditional plans and would better understand a simplified plan, but weaker evidence that a simplified plan would have strong appeal to consumers or change their healthcare choices.Publication What Makes Annuitization More Appealing?(Elsevier BV, 2014) Beshears, John; Choi, James J.; Laibson, David; Madrian, Brigitte; Zeldes, Stephen P.We conduct and analyze two large surveys of hypothetical annuitization choices. We find that allowing individuals to annuitize a fraction of their wealth increases annuitization relative to a situation where annuitization is an “all or nothing” decision. Very few respondents choose declining real payout streams over flat or increasing real payout streams of equivalent expected present value. Highlighting the effects of inflation increases demand for cost of living adjustments. Frames that highlight flexibility, control, and investment significantly reduce annuitization. A majority of respondents prefer to receive an extra “bonus” payment during one month of the year that is funded by slightly lower payments in the remaining months. Concerns about later-life income, spending flexibility, and counterparty risk are the most important self-reported motives that influence the annuitization decision.Publication The Effect of Providing Peer Information on Retirement Savings Decisions(Wiley-Blackwell, 2015) Beshears, John; Choi, James J.; Laibson, David; Madrian, Brigitte; Milkman, Katherine L.Using a field experiment in a 401(k) plan, we measure the effect of disseminating information about peer behavior on savings. Low-saving employees received simplified plan enrollment or contribution increase forms. A randomized subset of forms stated the fraction of age-matched coworkers participating in the plan or age-matched participants contributing at least 6% of pay to the plan. We document an oppositional reaction: the presence of peer information decreased the savings of nonparticipants who were ineligible for 401(k) automatic enrollment, and higher observed peer savings rates also decreased savings. Discouragement from upward social comparisons seems to drive this reaction.Publication Does Aggregated Returns Disclosure Increase Portfolio Risk Taking?(Oxford University Press (OUP), 2017-06-09) Beshears, John; Choi, James J.; Laibson, David; Madrian, BrigitteMany experiments have found that participants take more investment risk if they see returns less frequently, see portfolio-level returns (rather than each individual asset’s returns), or see long-horizon (rather than one-year) historical return distributions. In contrast, we find that such information aggregation treatments do not affect total equity investment when we make the investment environment more realistic than in prior experiments. Previously documented aggregation effects are not robust to changes in the risky asset’s return distribution or the introduction of a multi-day delay between portfolio choice and return realizations.Publication Liquidity in Retirement Savings Systems: An International Comparison(American Economic Association, 2015) Beshears, John; Choi, James J.; Hurwitz, Joshua; Laibson, David; Madrian, BrigitteWe compare the liquidity that six developed countries have built into their employer-based defined contribution (DC) retirement schemes. In Germany, Singapore, and the UK, withdrawals are essentially banned no matter what kind of transitory income shock the household realizes. By contrast, in Canada and Australia, liquidity is state-contingent. For a middle-income household, DC accounts are completely illiquid unless annual income falls substantially, in which case DC assets become highly liquid. The US stands alone in the universally high liquidity of its DC system: whether or not income falls, the penalties for early withdrawal are low or non-existent.
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