In recent years, the field of economics has been invigorated with the work of experimental behavioral psychologists. Their studies have demonstrated numerous ways in which human behavior does not correspond with the rational utility maximizer model of standard economic theory.
One of the most striking examples is the power of a default option to affect people’s choices. This is well illustrated by the rate at which people sign up to be organ donors in different countries.1 Given the shortage of organs, some countries have gone to great length to educate their populations about the need for organ donation, with little change in organ donation rates. But some countries have very high rates of people signing up to be organ donors. And the key difference in those countries is that people do not have to sign up to be organ donors, they are listed as organ donors by default.
When people are given an opt in option to sign-up as an organ donor, with the default being not to, a low percentage of people, fewer than 15%, check off that they want to be a donor. When people are given an opt out option as to not be an organ donor (the default being to donate), a remarkably high percentage of people, over 90%, signmup to be a donor. The decision people make to be a donor or not has little to do with what people know about organ donation nor about maximizing an individual’s utility; it has nearly everything to do with… wait for it… inertia.
Inertia is a powerful tool, one that can be used to help people improve their situations. Inertia has been used to encourage much better retirement saving behavior (as changing to an opt out approach leads to far greater participation in retirement plans than does requiring people to opt in to make their retirement contributions).
I imagine there are many ways to use this characteristic of human behavior, perhaps limited only by our imaginations. Giving patients a mind-numbing host of options for psoriasis treatment and asking them to choose from among them may only paralyze patients’ ability to choose and leave them in the default position of not doing anything. I am reminded of a patient who was truly suffering with horrible palmoplantar psoriasis, yet who could not bring herself to decide to use any of the many very reasonable treatments offered that would have helped. Instead, presenting her with a standard “default” option, one the doctor thought was in her best interest, along with information about other options she could choose, made it much easier for her to start on therapy.
Inertia is so powerful a tool as to raise issues of whether it is coercive to use. We should recognize that there is no choice as to whether to use inertia or not. There is always a default option. The question is not whether to use inertia or not, the question is whether to make the default option the best one or not.
Steven R. Feldman, MD, PhD
Chief Medical Editor
Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.
Reference
1. Davidai S, Gilovich T, Ross LD. The meaning of default options for potential organ donors. Prox Natl Acad Sci USA. 2012;109(38):15201-15205.
In recent years, the field of economics has been invigorated with the work of experimental behavioral psychologists. Their studies have demonstrated numerous ways in which human behavior does not correspond with the rational utility maximizer model of standard economic theory.
One of the most striking examples is the power of a default option to affect people’s choices. This is well illustrated by the rate at which people sign up to be organ donors in different countries.1 Given the shortage of organs, some countries have gone to great length to educate their populations about the need for organ donation, with little change in organ donation rates. But some countries have very high rates of people signing up to be organ donors. And the key difference in those countries is that people do not have to sign up to be organ donors, they are listed as organ donors by default.
When people are given an opt in option to sign-up as an organ donor, with the default being not to, a low percentage of people, fewer than 15%, check off that they want to be a donor. When people are given an opt out option as to not be an organ donor (the default being to donate), a remarkably high percentage of people, over 90%, signmup to be a donor. The decision people make to be a donor or not has little to do with what people know about organ donation nor about maximizing an individual’s utility; it has nearly everything to do with… wait for it… inertia.
Inertia is a powerful tool, one that can be used to help people improve their situations. Inertia has been used to encourage much better retirement saving behavior (as changing to an opt out approach leads to far greater participation in retirement plans than does requiring people to opt in to make their retirement contributions).
I imagine there are many ways to use this characteristic of human behavior, perhaps limited only by our imaginations. Giving patients a mind-numbing host of options for psoriasis treatment and asking them to choose from among them may only paralyze patients’ ability to choose and leave them in the default position of not doing anything. I am reminded of a patient who was truly suffering with horrible palmoplantar psoriasis, yet who could not bring herself to decide to use any of the many very reasonable treatments offered that would have helped. Instead, presenting her with a standard “default” option, one the doctor thought was in her best interest, along with information about other options she could choose, made it much easier for her to start on therapy.
Inertia is so powerful a tool as to raise issues of whether it is coercive to use. We should recognize that there is no choice as to whether to use inertia or not. There is always a default option. The question is not whether to use inertia or not, the question is whether to make the default option the best one or not.
Steven R. Feldman, MD, PhD
Chief Medical Editor
Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.
Reference
1. Davidai S, Gilovich T, Ross LD. The meaning of default options for potential organ donors. Prox Natl Acad Sci USA. 2012;109(38):15201-15205.
In recent years, the field of economics has been invigorated with the work of experimental behavioral psychologists. Their studies have demonstrated numerous ways in which human behavior does not correspond with the rational utility maximizer model of standard economic theory.
One of the most striking examples is the power of a default option to affect people’s choices. This is well illustrated by the rate at which people sign up to be organ donors in different countries.1 Given the shortage of organs, some countries have gone to great length to educate their populations about the need for organ donation, with little change in organ donation rates. But some countries have very high rates of people signing up to be organ donors. And the key difference in those countries is that people do not have to sign up to be organ donors, they are listed as organ donors by default.
When people are given an opt in option to sign-up as an organ donor, with the default being not to, a low percentage of people, fewer than 15%, check off that they want to be a donor. When people are given an opt out option as to not be an organ donor (the default being to donate), a remarkably high percentage of people, over 90%, signmup to be a donor. The decision people make to be a donor or not has little to do with what people know about organ donation nor about maximizing an individual’s utility; it has nearly everything to do with… wait for it… inertia.
Inertia is a powerful tool, one that can be used to help people improve their situations. Inertia has been used to encourage much better retirement saving behavior (as changing to an opt out approach leads to far greater participation in retirement plans than does requiring people to opt in to make their retirement contributions).
I imagine there are many ways to use this characteristic of human behavior, perhaps limited only by our imaginations. Giving patients a mind-numbing host of options for psoriasis treatment and asking them to choose from among them may only paralyze patients’ ability to choose and leave them in the default position of not doing anything. I am reminded of a patient who was truly suffering with horrible palmoplantar psoriasis, yet who could not bring herself to decide to use any of the many very reasonable treatments offered that would have helped. Instead, presenting her with a standard “default” option, one the doctor thought was in her best interest, along with information about other options she could choose, made it much easier for her to start on therapy.
Inertia is so powerful a tool as to raise issues of whether it is coercive to use. We should recognize that there is no choice as to whether to use inertia or not. There is always a default option. The question is not whether to use inertia or not, the question is whether to make the default option the best one or not.
Steven R. Feldman, MD, PhD
Chief Medical Editor
Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.
Reference
1. Davidai S, Gilovich T, Ross LD. The meaning of default options for potential organ donors. Prox Natl Acad Sci USA. 2012;109(38):15201-15205.
