Analyst: "Libertarian paternalism" needed for healthy nudging

By Brian Dolan
05:11 pm

You know those "Your Speed Limit Is..." signs on the side of the road? Turns out they are very effective. Michael Barrett, managing partner at Critical Mass Consulting, wondered whether the healthcare industry could learn a thing or two from those simple, roadside sentinels. Barrett made the case this morning during a presentation at the Healthcare Unbound conference here in Seattle, Washington.

Barrett noted that the importance of triggering behavioral changes has not been lost on the current administration -- President Obama has at least three trained behaviorists as advisers to the health policy group. What if instead of showing your current speed juxtaposed with the speed limit, the sign on the side of the highway showed your current caloric intake for the day next to the daily recommended number of calories, Barrett asked the audience. 

These real-time cues for eating habits or other health decisions "nudge" us into making behavioral changes, and even though it's a top-down approach, Barrett called it Libertarian paternalism. They are nudges not mandates, he argued, and they need to be easily avoided and ignored if a person so desires. 

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Of course, we don't need a roadside sign for real-time cues for behavioral health changes -- we almost all have mobile phones in our pockets for that. 

Read on for the healthcare industry timeline that Barrett presented at a different conference earlier this year. The presentation aimed to contextualize the wireless healthcare "revolution."

Barrett began his talk with a rough timeline of healthcare dating back to before the 18th Century. He then went on to contextualize the wireless healthcare opportunity and outline some challenges this "revolution" still faces. Here's a synopsis of Barrett's timeline:

18th Century and before: Before society institutionalized healthcare, it was wireless. Doctors or caregivers would visit homes or places of work. These were "hands-on" care givers.
19th Century: Pioneering hospitals like Massachusetts General Hospital developed enormous places of care that led to the professionalization of healthcare throughout the 19th century.
1950s: The idea that care could take place outside of the home began to take hold: In 1950 40 percent of doctor visits still occurred in the home.
1965: Medicare includes coverage for home health-just barely. A "thread" still existed, though.
1980s: We began (already) to focus on aging baby boomers and found that enormous costs will be rung up because of them. Chronic care studies showed that "90 percent of diabetes care is self care" effectively.
1996: Kaiser launches an online health site for its members to instruct them and their family members on how to access care.
1999: The real beginnings of remote patient monitors, which began as wired devices connected to plain old telephony lines hit the market.
2002: Forrester Research authors a report called Healthcare Unbound, which recognizes a trend toward de-institutionalizing healthcare and returning it to its roots as a "wireless" anytime, anywhere field.



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