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Self-Control and Demand for Preventive Health: Evidence from Hypertension in India

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  • Bai, Liang
  • Handel, Benjamin
  • Miguel, Edward
  • Rao, Gautam

Abstract

Self-control problems constitute a potential explanation for the underinvestment in preventive health in low-income countries. Behavioral economics offers a tool to solve such problems: commitment devices. We conduct a field experiment to evaluate the effectiveness of different types of theoretically motivated commitment contracts in increasing preventive doctor visits by hypertensive patients in rural India. Despite achieving high take-up of such contracts in some treatment arms, we find no effects on actual doctor visits or individual health outcomes. A substantial number of individuals pay for commitment but fail to follow through on the doctor visit, losing money without experiencing health benefits. We develop and structurally estimate a prespecified model of consumer behavior under present bias with varying levels of naiveté. The results are consistent with a large share of individuals being partially naive about their own self-control problems: sophisticated enough to demand some commitment but overly optimistic about whether a given level of commitment is sufficiently strong to be effective. The results suggest that commitment devices may in practice be welfare diminishing, at least in some contexts, and serve as a cautionary tale about their role in health care.

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  • Bai, Liang & Handel, Benjamin & Miguel, Edward & Rao, Gautam, 2021. "Self-Control and Demand for Preventive Health: Evidence from Hypertension in India," Department of Economics, Working Paper Series qt3w3154kb, Department of Economics, Institute for Business and Economic Research, UC Berkeley.
    • Handle: RePEc:cdl:econwp:qt3w3154kb
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    5. Mariana Carrera & Heather Royer & Mark Stehr & Justin Sydnor & Dmitry Taubinsky, 2022. "Who Chooses Commitment? Evidence and Welfare Implications," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 89(3), pages 1205-1244.
    6. Alexander M. Danzer & Helen Zeidler, 2024. "Present Bias in Choices over Food and Money," CESifo Working Paper Series 11454, CESifo.
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    8. Andrej Woerner, 2021. "Overcoming Time Inconsistency with a Matched Bet: Theory and Evidence from Exercising," CESifo Working Paper Series 9503, CESifo.
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    10. Frank Schilbach, 2019. "Alcohol and Self-Control: A Field Experiment in India," American Economic Review, American Economic Association, vol. 109(4), pages 1290-1322, April.
    11. Laura Derksen & Jason Kerwin & Natalia Ordaz Reynoso & Olivier Sterck, 2021. "Appointments: A More Effective Commitment Device for Health Behaviors," Papers 2110.06876, arXiv.org.
    12. Sayantan Ghosal & Smarajit Jana & Anandi Mani & Sandip Mitra & Sanchari Roy, 2022. "Sex Workers, Stigma, and Self-Image: Evidence from Kolkata Brothels," The Review of Economics and Statistics, MIT Press, vol. 104(3), pages 431-448, May.
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    14. Danzer, Alexander M. & Zeidler, Helen, 2024. "Present Bias in Choices over Food and Money," IZA Discussion Papers 17415, Institute of Labor Economics (IZA).
    15. Anett John & Kate Orkin, 2022. "Can Simple Psychological Interventions Increase Preventive Health Investment?," Journal of the European Economic Association, European Economic Association, vol. 20(3), pages 1001-1047.
    16. Bertrand Lefebvre & Abhiroop Mukhopadhyay & Vastaf and only if the other epistemic institutions are ineptimal strategy involves a mixture of confirmatory and (a minimal amount of) contrarian re- porti, 2024. "Who bears the distance cost of public primary healthcare? Hypertension among the elderly in rural India," Discussion Papers 24-02, Indian Statistical Institute, Delhi.
    17. Woerner, Andrej, 2023. "Overcoming Time Inconsistency with a Matched Bet: Theory and Evidence from Exercising," VfS Annual Conference 2023 (Regensburg): Growth and the "sociale Frage" 277711, Verein für Socialpolitik / German Economic Association.
    18. de Walque, Damien, 2020. "The use of financial incentives to prevent unhealthy behaviors: A review," Social Science & Medicine, Elsevier, vol. 261(C).
    19. Eliana Carranza & Aletheia Donald & Florian Grosset & Supreet Kaur, 2022. "The Social Tax: Redistributive Pressure and Labor Supply," NBER Working Papers 30438, National Bureau of Economic Research, Inc.
    20. Dizon-Ross, Rebecca & Aggarwal, Shilpa & Zucker, Ariel, 2020. "Incentivizing Behavioral Change: The Role of Time Preferences," CEPR Discussion Papers 14751, C.E.P.R. Discussion Papers.
    21. Alexander M. Danzer & Helen Zeidler, 2024. "Present Bias in Choices over Food and Money," Working Papers 239, Bavarian Graduate Program in Economics (BGPE).
    22. Gallegos, Sebastian & Roseth, Benjamin & Cuesta, Ana & Sánchez, Mario, 2023. "Increasing the take-up of public health services: An at-scale experiment on digital government," Journal of Public Economics, Elsevier, vol. 227(C).
    23. Zarko Kalamov & Marco Runkel, 2020. "Present-Focused Preferences and Sin Goods Consumption at the Extensive and Intensive Margins," CESifo Working Paper Series 8237, CESifo.

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    More about this item

    Keywords

    Economics; Applied Economics; Prevention; Clinical Research; Good Health and Well Being; Econometrics; Banking; finance and investment; Applied economics;
    All these keywords.

    JEL classification:

    • D91 - Microeconomics - - Micro-Based Behavioral Economics - - - Role and Effects of Psychological, Emotional, Social, and Cognitive Factors on Decision Making
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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