The state-of-the-art literature at the interface between experimental and behavioral economics and health economics is reviewed by identifying and discussing 10 areas of potential debate about behavioral experiments in health. By doing so, the different streams and areas of application of the growing field of behavioral experiments in health are reviewed, by discussing which significant questions remain to be discussed, and by highlighting the rationale and the scope for the further development of behavioral experiments in health in the years to come.
Matteo M. Galizzi and Daniel Wiesen
In many countries of the world, consumers choose their health insurance coverage from a large menu of often complex options supplied by private insurance companies. Economic benefits of the wide choice of health insurance options depend on the extent to which the consumers are active, well informed, and sophisticated decision makers capable of choosing plans that are well-suited to their individual circumstances. There are many possible ways how consumers’ actual decision making in the health insurance domain can depart from the standard model of health insurance demand of a rational risk-averse consumer. For example, consumers can have inaccurate subjective beliefs about characteristics of alternative plans in their choice set or about the distribution of health expenditure risk because of cognitive or informational constraints; or they can prefer to rely on heuristics when the plan choice problem features a large number of options with complex cost-sharing design. The second decade of the 21st century has seen a burgeoning number of studies assessing the quality of consumer choices of health insurance, both in the lab and in the field, and financial and welfare consequences of poor choices in this context. These studies demonstrate that consumers often find it difficult to make efficient choices of private health insurance due to reasons such as inertia, misinformation, and the lack of basic insurance literacy. These findings challenge the conventional rationality assumptions of the standard economic model of insurance choice and call for policies that can enhance the quality of consumer choices in the health insurance domain.
Punishment has been regarded as an important instrument to sustain human cooperation. A great deal of experimental research has been conducted to understand human punishment behavior, in particular, informal peer punishment. What drives individuals to incur cost to punish others? How does punishment influence human behavior? Punishment behavior has been observed when the individual does not expect to meet the wrongdoers again in the future and thus has no monetary incentive to punish. Several reasons for such retributive punishment have been proposed and studied. Punishment can be used to express certain values, attitudes, or emotions. Egalitarianism triggers punishment when the transgression leads to inequality. The norm to punish the wrongdoers may also lead people to incur costs to punish even when it is not what they intrinsically want to do. Individuals sometimes punish wrongdoers even when they are not the victim. The motivation underlying the third-party punishment can be different than the second-party punishment. In addition, restricting the punishment power to a third party can be important to mitigate antisocial punishment when unrestricted second-party peer punishment leads to antisocial punishments and escalating retaliation. It is important to note that punishment does not always promote cooperation. Imposing fines can crowd out intrinsic motivation to cooperate when it changes people’s perception of social interactions from a generous, non-market activity to a market commodity and leads to more selfish profit-maximizing behavior. To avoid the crowding-out effect, it is important to implement the punishment in a way that it sends a clear signal that the punished behavior violates social norms.
Jacob K. Goeree, Philippos Louis, and Jingjing Zhang
Majority voting is the predominant mechanism for collective decision making. It is used in a broad range of applications, spanning from national referenda to small group decision making. It is simple, transparent, and induces voters to vote sincerely. However, it is increasingly recognized that it has some weaknesses. First of all, majority voting may lead to inefficient outcomes. This happens because it does not allow voters to express the intensity of their preferences. As a result, an indifferent majority may win over an intense minority. In addition, majority voting suffers from the “tyranny of the majority,” i.e., the risk of repeatedly excluding minority groups from representation. A final drawback is the “winner-take-all” nature of majority voting, i.e., it offers no compensation for losing voters. Economists have recently proposed various alternative mechanisms that aim to produce more efficient and more equitable outcomes. These can be classified into three different approaches. With storable votes, voters allocate a budget of votes across several issues. Under vote trading, voters can exchange votes for money. Under linear voting or quadratic voting, voters can buy votes at a linear or quadratic cost respectively. The properties of different alternative mechanisms can be characterized using theoretical modeling and game theoretic analysis. Lab experiments are used to test theoretical predictions and evaluate their fitness for actual use in applications. Overall, these alternative mechanisms hold the promise to improve on majority voting but have their own shortcomings. Additional theoretical analysis and empirical testing is needed to produce a mechanism that robustly delivers efficient and equitable outcomes.
Iñigo Hernandez-Arenaz and Nagore Iriberri
Gender differences, both in entering negotiations and when negotiating, have been proved to exist: Men are usually more likely to enter into negotiation than women and when negotiating they obtain better deals than women. These gender differences help to explain the gender gap in wages, as starting salaries and wage increases or promotions throughout an individual’s career are often the result of bilateral negotiations. This article presents an overview of the literature on gender differences in negotiation. The article is organized in four main parts. The first section reviews the findings with respect to gender differences in the likelihood of engaging in a negotiation, that is, in deciding to start a negotiation. The second section discusses research on gender differences during negotiations, that is, while bargaining. The third section looks at the relevant psychological literature and discusses meta-analyses, looking for factors that trigger or moderate gender differences in negotiation, such as structural ambiguity and cultural traits. The fourth section presents a brief overview of research on gender differences in non- cognitive traits, such as risk and social preferences, confidence, and taste for competition, and their impact in explaining gender differences in bargaining. Finally, the fifth section discusses some policy implications. An understanding of when gender differences are likely to arise on entering into negotiations and when negotiating will enable policies to be created that can mitigate current gender differences in negotiations. This is an active, promising research line.
Ana Balsa and Carlos Díaz
Health behaviors are a major source of morbidity and mortality in the developed and much of the developing world. The social nature of many of these behaviors, such as eating or using alcohol, and the normative connotations that accompany others (i.e., sexual behavior, illegal drug use) make them quite susceptible to peer influence. This chapter assesses the role of social interactions in the determination of health behaviors. It highlights the methodological progress of the past two decades in addressing the multiple challenges inherent in the estimation of peer effects, and notes methodological issues that still need to be confronted. A comprehensive review of the economics empirical literature—mostly for developed countries—shows strong and robust peer effects across a wide set of health behaviors, including alcohol use, body weight, food intake, body fitness, teen pregnancy, and sexual behaviors. The evidence is mixed when assessing tobacco use, illicit drug use, and mental health. The article also explores the as yet incipient literature on the mechanisms behind peer influence and on new developments in the study of social networks that are shedding light on the dynamics of social influence. There is suggestive evidence that social norms and social conformism lie behind peer effects in substance use, obesity, and teen pregnancy, while social learning has been pointed out as a channel behind fertility decisions, mental health utilization, and uptake of medication. Future research needs to deepen the understanding of the mechanisms behind peer influence in health behaviors in order to design more targeted welfare-enhancing policies.