One challenge to incorporating social incentives into insurance plans or other aspects of health care is the extent to which we privilege privacy. Although protecting privacy is important, David Asch notes that “it’s amazing what people are tweeting about their own health right now. For every person who’s fundamentally concerned about privacy . . . there are 100 who are fundamentally exhibitionists in some way.”
In other words, people are willing to be more social than you might think, and we could harness this willingness for social incentives. “There might be little tricks we could think of to make our everyday activities more social that would actually be very comfortable for us,” says Asch. He notes, for example, that he takes medications in the bathroom when he brushes his teeth. “I’m not trying to be secretive about my medication; it just happens when I happen to be alone,” he explains. But if he moved those medications to the kitchen, where they would be seen, his adherence might increase.
“There are two forces at play,” adds Niteesh Choudhry. “When we think about engagement strategies as a whole, we often think about the idea that they need to at some level be customized or personalized.” But targeting, customized messaging, focusing on barriers to adherence, and other personalization can be at odds with privacy restrictions, Choudhry explains. For example, you might receive a generic text message to pick up your medication that is sent at the same time to every patient, which can’t be customized because of privacy laws.
“Privacy laws are critical here — no one wants anything done inappropriately,” says Choudhry, “but we at some level have to come down on where we stand. What’s the greater social good, and what are we willing to give up in terms of gaining something that all of us benefit from?”
From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.