Introduction

Consider the following selective evidence of human behaviour in the domain of healthcare. The numeric-cognition feeds typically provided during public vaccination campaigns are less effective than affect-based perception of risk.1 It is common to avoid seeing doctors and/or doing health checks because of anxiety and fear of receiving bad results. The latter means that a perceived ‘loss today’ in the health status has a stronger impact than a ‘gain tomorrow’, namely preventing or curing a potential disease.2 Clinicians fail to act on available knowledge and guidelines despite the intention to do so.3

Instead, consider now the following couple of examples of choice architectures capable of offsetting erroneous conducts. Recent trial studies show that it is enough to change the default settings of electronic order sets to dramatically ‘improve’ clinicians prescribing behaviours.4 A lottery-based financial incentive increased warfarin adherence and anticoagulation control.5

What do these examples have in common? They exemplify the heuristics and biases and the counteracting ‘nudges’ that in the past decade have been presented as part of a behavioural sciences-dictated policy agenda. Altering prescription activities by changing defaults in electronic order sets, for instance, is just a very simple example of a ‘nudge’ leveraging the ‘status quo bias’ to steer clinicians toward a ‘normatively’ defined ‘better’ behaviour. This is achieved by framing the choice set without restricting available options, in other words, acting over presentation of the decision problem, and not on the constraints for the decision maker. This philosophy of policy intervention has been labelled ‘libertarian paternalism’ because by not affecting the options available in the choice set it can be deemed to be libertarian from a consequentialist point of view, while being paternalistic in the sense of trying to induce ‘better’ choices.6

The approach is grounded in behavioural economics (BE), …