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abstract

The majority of U.S. adults do not receive an annual influenza vaccination. Behavioral economics tools can be harnessed to encourage health behaviors. Specifically, scheduling patients by default for a flu shot appointment leads to higher vaccination rates at a medical practice than does merely encouraging flu shot appointments. It is not known, however, whether default appointments actually increase net vaccination or merely displace vaccinations from other venues. In the current field experiment, we examined the use of default appointments in a large medical practice and established that automatically scheduled appointments increased the total vaccination rate by 10 percentage points within the practice without displacing vaccinations that patients would otherwise have received in other settings. This increased vaccination rate came at the cost of a high no-show rate. These findings point to an effective way to increase vaccination rates and may offer a cost-saving measure in the scope of accountable care organizations.

Imagine Amy and Beth. Both receive letters from their doctor's office about flu shots. Amy's letter simply explains that flu shots are available and that if she would like an appointment for one, she should please call the office. Beth's letter also states that flu shots are available but adds that she has been given a flu shot appointment for next Thursday at 7:30 a.m., although she can cancel or reschedule if she wishes. Which of these two women is more likely to receive a flu shot at her doctor's office?

The answer matters because, in the 2015-2016 flu season, only 42% of U.S. adults received an annual influenza vaccine (flu shot),1,2 even though the shots are conveniently available at many workplaces, doctors' offices, drugstores, and walk-in clinics, often at no out-of-pocket cost. The low vaccination rate resulted in an annual economic burden estimated at $5.8 billion, a figure that includes the costs of hospitalizations, doctors' visits, deaths, and lost workdays (see the sidebar Selected Recent Flu Vaccination Statistics). That raises an urgent question for behavioral and social scientists: Can we nudge people to get a flu shot just as we have nudged people to sign up for organ donation and retirement savings?3,4

In the example above, Beth has a flu shot appointment by default. The default effect-meaning the tendency for people to...

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