The five bad habits of healthcare

Think about the last time you were ill, or someone close to you was in hospital. As you sat in the waiting room, were you calm and collected? Was your mind clear and ready to make optimal decisions about the future and which course of treatment to choose?

No, you may think, but at least I could trust the doctors to be the voice of pure reason. They are trained to weigh up options coolly and accurately: they always select the best available one, and for the least cost.

In fact, all our decisions (whether we are patients, professionals, providers or policymakers) are influenced by mental shortcuts, biases and the context in which they are made – not just by the objective assessment of the benefits of each available option. From social psychology to experimental economics, new evidence strengthens this claim every day.

The problem is that our healthcare systems do not reflect this fact; they depend on users, providers and professionals always acting like rational agents. As a result, they struggle to address the fact that the ways we act encourage over-prescription, over-consumption and the inefficient allocation of healthcare resources. We urgently need to address this problem: in the OECD countries, health expenditure has, on average, exceeded the rate of economic growth by 2% annually for the past 60 years.  In many countries, this ever-increasing expenditure will put unsustainable demands on public resources and crowd-out other important areas of spending.

We think an important part of the solution is to create a new approach based on evidence of how people actually behave. Building on the work of the 2010-2011 World Economic Forum Healthcare Industry Global Agenda Council, we have identified five important and pervasive “bad habits” that contribute to this spending problem:

1. Favouring current practice over the best available evidence
2. Following what others are doing even when it is wrong
3. Behaving as if more healthcare is identical to better healthcare
4. Focusing on illness at the expense of prevention
5. Failing to present information or choices effectively

As our report shows, by recognising how these bad habits come about, we can redesign health systems to counter them – or even harness them. To aid this task, we present a simple framework called “MINDSPACE” to help governments and healthcare managers integrate behavioural insights into their policy-making.

But this is not just a case of adopting new approaches – the failure to recognise these bad habits has also blunted our existing tools for reducing healthcare costs. We literally cannot afford for this to go on any longer; as the saying goes, “conquer your bad habits or they will conquer you.”

Authors: Ara Darzi, Steve Beales, Mike Hallsworth, Dominic King, Michael Macdonnell and Ivo Vlaev from the Institute of Global Health Innovation, Imperial College Kondon

Pictured: Jazmine Raygoza (R) fills out a questionnaire from her surgeon Dr. Michael Snyder at Rose Medical Center in Denver June 20, 2011 just before Jazmine’s Lap-Band surgery. After trying multiple diets and exercise, Jazmine, 17, decided on the Lap-Band treatment with the encouragement of her mother, who recently had a gastric bypass herself. About 17 percent of American kids and teens are obese, according to the Centers for Disease Control and Prevention. Picture taken June 20, 2011. REUTERS/Rick Wilking