title: Health insurance coverage and take-up: lessons from behavioral economics.
abstract: BACKGROUND
  Millions of uninsured Americans ostensibly have insurance available to them-many at very low cost-but do not take it up. Traditional economic analysis is based on the premise that these are rational decisions, but it is hard to reconcile observed enrollment patterns with this view. The policy prescriptions that the traditional model generates may thus fail to achieve their goals. Behavioral economics, which integrates insights from psychology into economic analysis, identifies important deviations from the traditional assumptions of rationality and can thus improve our understanding of what drives health insurance take-up and improved policy design.
  
  
  METHODS
  Rather than a systematic review of the coverage literature, this article is a primer for considering issues in health insurance coverage from a behavioral economics perspective, supplementing the standard model. We present relevant evidence on decision making and insurance take-up and use it to develop a behavioral approach to both the policy problem posed by the lack of health insurance coverage and possible policy solutions to that problem.
  
  
  RESULTS
  We found that evidence from behavioral economics can shed light on both the sources of low take-up and the efficacy of different policy levers intended to expand coverage. We then applied these insights to policy design questions for public and private insurance coverage and to the implementation of the recently enacted health reform, focusing on the use of behavioral insights to maximize the value of spending on coverage.
  
  
  CONCLUSIONS
  We concluded that the success of health insurance coverage reform depends crucially on understanding the behavioral barriers to take-up. The take-up process is likely governed by psychology as much as economics, and public resources can likely be used much more effectively with behaviorally informed policy design.
authors.affiliation: Harvard School of Public Health, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Baicker
authors.forename: William J
authors.initials: WJ
authors.lastname: Congdon
authors.forename: Sendhil
authors.initials: S
authors.lastname: Mullainathan
mesh_terms: D000328:Adult; D002648:Child; D002669:Child Welfare / Q000191:economics; D003657:Decision Making; D060909:Economics, Behavioral; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000706:statistics & numerical data; D018166:Health Care Reform; D006291:Health Policy; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000458:organization & administration* / Q000706:statistics & numerical data; D008484:Medicaid; D017057:Medically Uninsured / Q000523:psychology*; D058991:Patient Protection and Affordable Care Act; D014481:United States