Abstract
Background: To enable health-promoting behavioral changes among the population, nudging emerges as a successful tool to increase participation in prevention interventions among all population groups, regardless income, education and other socioeconomic factors.
Approach: Increasing the utilization of preventive services presents a significant challenge in health policy. The goal of the 2023 nudging project, “Healthy Together”, implemented by the Social Insurance for the Self-Employed, was to promote preventive medical check-ups with general practitioners. A monetary incentive of €100 was implemented for participating patients.
The check-up consists of different health measures according to a guideline that was concluded by the Austrian Medical Chamber and the Social Insurance for the Self-Employed.
It includes questionnaires, physical examinations and diagnostics, providing the physician with a general overview of the patient’s health status. Depending on the findings, further tests may be recommended, such as mammograms, Pap smears, colonoscopies, or urological examinations, tailored to the patient’s risk profile.
One approach increasingly adopted in healthcare promotion is the concept of “nudging” as described by Thaler and Sunstein. “Nudging” is based on the principle of libertarian paternalism and aims to encourage individual behavioral changes through subtle incentives without resorting to additional regulatory measures (Thaler & Sunstein, 2008, S. 14-15, S. 106-107). Low-threshold nudging interventions, aligned with the public health paradigm of equal opportunities, can promote acceptance and increase participation, even among vulnerable populations (Murayama et al., 2023, S.9-11).
Results: In 2022, before the introduction of the nudge, 145,893 individuals had regularly participated in preventive medical check-ups. In 2023, an additional 67,307 patients were enrolled, which represents an increase of 46%.
Furthermore the initiative motivated new participants, that have not been part of the program in recent years. This subpopulation represent 52,7% of the intervention group.
In the age group under 30 the number of new participants in 2023 exceeded the number of existing frequent attendees by 100%. Among the 30-39 age group, participation rose by 78%, in the 40-49 age group by 56%. Even in the 80-89 age group, an increase of nearly 30% was documented.
Regarding the prosperity of the participants, an increase of 80% was observed within the low income population.Income levels 2 to 5 indicated an increase from 38% to 54%.
No statistically significant differences were found in the categories of education and gender, with showing high growth rates of approximately 50% in all subpopulations.
Implications: Nudges are designed to influence individual behavior through intrinsic motivation rather than financial rewards. From a health policy perspective, integrating nudging approaches into the toolkit of public health measures for health promotion and prevention is strongly recommended. These strategies should take precedence over more coercive measures, such as legally mandated sanctions. The 2023 initiative showed increases in vulnerable populations such as the socially disadvantaged.
Enhancing the utilization of preventive services represents a major challenge for health policy makers. Based on the results of the presented nudging intervention in 2023, the SVS is dedicating the 2024 initiative to dental health, and 2025 to cancer prevention.