Mitesh Patel, MD, MBA, is a Robert Wood Johnson Foundation Clinical Scholar and senior fellow at the Leonard Davis Institute for Health Economics at the University of Pennsylvania.  He is a practicing physician at the Philadelphia Veteran Affairs Medical Center; and author of Clinical Wards Secrets, a guide for medical students transitioning from the classroom to the hospital wards. This post is part of the "Health Care in 2013" series.

While most people spend a few hours a year visiting the doctor, they spend another 5,000 waking hours without any direct contact from the U.S. health care system.  There has been an increasing amount of attention on how to design systems that encourage healthy behaviors among the population during their everyday activities.  Insights from behavioral economics provide opportunities to design systems that monitor, incentivize and provide feedback to encourage these changes. 

One proposal to change behavior is to increase price transparency in the U.S, with initiatives at the state and federal levels.  Lessons from other industries and concepts from behavioral economics demonstrate that this must be designed carefully to increase the likelihood that price transparency changes behavior. 

One example is the use of calorie-labeling in fast food restaurants.  While its intended outcome is to reduce consumer consumption, there are several reasons why it has thus far not been very successful. Consumers may not understand the caloric information or the problem may be self-control and not related to information at all. 

Using concepts from behavioral economics such as framing the information or making it more salient could improve its impact on reducing calorie consumption.

As the New Year approaches, millions of Americans will make resolutions to improve their diet, increase their exercise, or to quit smoking.  Let’s do our part to design systems that help our population meet their goals and increase healthy behavior. 

Natasha Dow Schüll, PhD, MA, is a cultural anthropologist and associate professor at the Massachusetts Institute of Technology's Program in Science, Technology and Society. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2003-2005). Her recent book, Addiction by Design: Machine Gambling in Las Vegas, examines the ways that the gambling industry has designed gambling machines that encourage addiction.

Human Capital Blog: In your book, you describe how electronic gambling machines—the modern equivalent of slot machines—are designed in such a way that they encourage addiction. Tell us about that, please.

Natasha Dow Schüll: If you have never actually been in a Las Vegas casino and your idea of it comes from a James Bond movie, you'd be surprised by what you'd find. Of course they still have card games and roulette wheels, but most of the money casinos make is from electronic gambling machines, which are amazingly sophisticated versions of the classic three-reel slot machine. Every aspect of their design—the hardware, the software, the math, even the seating components—is carefully designed to keep players at the machine, playing game after game. Play is simple and amazingly fast—it takes only three to four seconds per spin. The machines are programmed so gamblers win every now and then, and they give audiovisual feedback to encourage them to continue. They induce players to gamble quickly and repeatedly, developing a sort of rhythmic flow that can sweep them away. Gamblers talk about getting into a "zone" where everything but the game just drops out of their awareness. After a while, they crave the zone itself, so it stops being about beating the machine and becomes instead about staying on the machine for as long as they can so they can be in that zone. They're addicted, and they develop all the behaviors of an addict as a result.

My point is that it's no accident; the machines are designed to drive the kinds of behavior—playing faster, longer, and more intensively—that turns gamblers into addicts.