Persuasion and behavior change strategies seek to influence how providers practice medicine and how patients make health decisions — without relying solely on financial incentives or regulatory mandates. These 'softer' policy instruments work through information, education, social norms, and nudges. While often less powerful than payment or regulatory reforms, behavioral interventions can be highly cost-effective and are essential complements to structural reforms.
Found that higher cost-sharing significantly reduced overall healthcare utilization (Efficiency) but had little to no significant impact on objective Health Status for the average adult, demonstrating the price elasticity of health behavior.
The consensus price elasticity of cigarette demand is approximately -0.4 in high-income countries and -0.4 to -0.8 in low- and middle-income countries. A 10% price increase reduces consumption by 4–8%. Youth and low-income populations are most price-responsive. Industry documents confirmed that companies viewed tax increases as the greatest threat to consumption.
Countries with opt-out (presumed consent) defaults had dramatically higher donation consent rates — often exceeding 90% — compared to opt-in countries where rates were typically 10-30%. Laboratory experiments confirmed the causal mechanism: defaults powerfully shape decisions through status quo bias and implied endorsement, even for consequential health choices.
Children in treatment households experienced approximately a 23% reduction in the incidence of illness, an 18% reduction in anemia, and a 1–4% increase in height. Preventive health care visits increased by more than half.
Multifaceted interventions combining educational outreach, reminders, and audit-and-feedback produced the most consistent behavior change. Passive guideline dissemination alone had minimal effect. Median absolute improvement in care processes ranged from 6-10% for active implementation strategies. No single strategy was reliably superior across all settings.
The average effect size of health communication campaigns was r = 0.05, representing a small but statistically significant effect on health behaviors at the population level. Campaign effects varied by topic: seatbelt use and oral health campaigns were most effective, while campaigns targeting diet and physical activity showed smaller effects. Effects were larger when campaigns were combined with community-level interventions.
Copayment reductions of $5–$17 per prescription increased medication adherence by 2–4 percentage points, with the largest gains for statins and diabetes medications. The adherence improvement was sustained over the two-year study period.
Educational meetings alone improved professional practice by a median 6% absolute improvement in compliance with desired practice. Interactive workshops were more effective than didactic lectures. Mixed interactive and didactic formats were more effective than either alone. Effects on patient outcomes were smaller and less consistently demonstrated than effects on practice behavior.
Overall recovery was 65.0% (intervention) vs. 52.9% (control). In public facilities, the effect was dramatic: 65.9% vs. 42.5% recovery (RR 1.55). No significant difference in private facilities where baseline care was already better.
Audit and feedback produced a median 4.3% absolute improvement in compliance with desired practice (IQR 0.5-16%). Effects were larger when baseline performance was low, when feedback was delivered by a supervisor or colleague, when delivered more than once, when delivered both verbally and in writing, and when it included explicit targets and an action plan.
Under-5 mortality showed a dose-response relationship with BFP coverage: approximately 17%, 32%, and 53% reductions at intermediate, high, and consolidated coverage levels respectively. Effects were strongest for poverty-related causes (malnutrition and diarrhea).
Decision aids improved knowledge (MD 13.3 points on 100-point scale), accuracy of risk perceptions, and congruence between values and choices. Patients using decision aids chose major elective surgery 20% less often and were more likely to choose conservative management. No adverse effects on satisfaction or anxiety.