Behavioural economics and financial incentives

For better or worse, money makes the world go around. Without it, you may find yourself stuck in place, or worse - left behind.

Following on from our previous conversation about race, health and society, we are joined again by Professor Leonard Egede from the Medical College of Wisconsin. In todays discussion, he walks us through the economics of public health - diabetes in particular - and how different incentive plans could help level the playing field for accessing care.

Read the original article: https://doi.org/10.1371/journal.pone.0248762 

Transcript

00:00:05 Will Mountford 

Hello. I'm Will, welcome to ResearchPod. It is an unavoidable fact that money makes the world go round. Conversely, not having money can find you stuck in place or worse, left behind. 

00:00:19 Will Mountford 

Following on from our previous conversation about race, health and society, we are joined again by Professor Leonard Egede from the Medical College of Wisconsin. 

00:00:28 Will Mountford 

In today's discussion, he walks us through the economics of public health, diabetes in particular, and how different incentive plans could help level the playing field for accessing care. 

00:00:44 Will Mountford 

Joining us once again, Professor Egede. 

00:00:46 Prof Leonard Egede 

Glad to be here. 

00:00:47 Will Mountford 

Now people who have listened to your first interview will know that a lot of your research touches on aspects of race in science and society and kind of the social well-being aspects. Could you give us a bit of an introduction to what we're talking through today? 

00:01:00 Prof Leonard Egede 

Yeah. So I think the last time we talked about some of the social determinants of health, structural inequalities and then structural determinants of. 

00:01:08 Prof Leonard Egede 

Out. And so today we are transitioning to the whole concept of behavioral economics and how financial incentives can be used to actually motivate behavioral change in populations where behavior change is really difficult to achieve. 

00:01:22 Will Mountford 

Yeah, the threads between income and well-being and function in society and equality seem to be very tangled from what I've read of your work and what I can see of the world of large. 

00:01:33 Will Mountford 

So if we could start pulling on some of those to see whether pieces come together, could you tell me about maybe some of the existing literature? What does the world look like at the moment in terms of how financial incentives and health interventions are related? 

00:01:48 Prof Leonard Egede 

Yeah. So it's very clear that income and wealth, though they are different, mean different things, but actually are connected. So income is really more about how much you make year to year, whereas wealth is historical information. You actually have. And so combined, it's very clear that those who are wealthier tend to have better health outcomes. That's because they have access to resources, they have access to. 

00:02:08 Prof Leonard Egede 

Less healthcare possible. They tend to have better built environment, housing, transportation and so where we are then asking the questions since we know that these differences exist. 

00:02:18 Prof Leonard Egede 

There's the whole concept of how do you then leverage income and wealth to actually improve health and health health outcomes? One way to think about that is that if you had all the resources in the world, you could just change people's financial situation and just give them money. And so there are three areas or three. 

00:02:38 Prof Leonard Egede 

Ways that this wealth and income issues being focused on one is the whole idea of the concept of income supplemental. 

00:02:46 Prof Leonard Egede 

So income supplementation says someone has a base level of income, and then you can lift them up by giving a little bit extra to move them to some kind of minimum livable wage. So an amount of income that will allow them have a meaningful existence, and this will vary from country to country. So that's income, supplementation, income, supplementation is a little bit different from universal. 

00:03:06 Prof Leonard Egede 

Basic income. Your visual basic income is essentially what you say we're actually going to give you money to essentially stabilize people across the board. 

00:03:15 Prof Leonard Egede 

And so, with income supplementation, the amount is given is usually limited. In the US, it's roughly about between 300 and $500, just to help supplement living expenses, whereas universal basic income is essentially saying we're gonna lift you to a certain threshold and the amounts that's spent in that is typically in the thousands of range actually move people. 

00:03:36 Prof Leonard Egede 

And then the third area that is kind of tangled in that whole conversation is the whole issue of incentives, the difference between universal basic income and incentives is that financial incentives have nothing to do with your base income. It's really about motivation for behavior. So whether you're rich or poor, everyone responds to financial incentives. 

00:03:55 Prof Leonard Egede 

When we use the word income supplementation, we're talking about people who are limited resources, universal basic income. People have limited resources, but with incentives, it applies to everyone, and it's just one of the tools available to change behavior. 

00:04:07 Prof Leonard Egede 

So the idea with incentives is that we have with something called intrinsic and extrinsic motivation. Intrinsic motivation is what happens when you have decided you've owned the behaviour and you are changing behavior because of your internal motivation, whereas extrinsic and the things outside of you that may help you nudge you towards behavior, financial incentives. 

00:04:27 Prof Leonard Egede 

Are one of those extrinsic motivators they nudge you towards behavior because they essentially get you to stop something, and hopefully you can then transition from an extrinsic to intrinsic motivation. 

00:04:43 Will Mountford 

And when we look at the US as kind of a geographical sense of where these things might work and for what kind of people in those locations, this might work for, how does the existing barriers in terms of wealth disparity reflect for who is best placed to receive those incentives? 

00:05:01 Prof Leonard Egede 

Yeah. So I think what we try to clarify. 

00:05:04 Prof Leonard Egede 

Is that so? If you look at the US statistics from the census and statistics, the median household wealth of the non Hispanic white population is roughly about 100 and 8888 thousand, whereas for black households it's roughly about 14,000. And for Hispanic households roughly about 32,000. So there's huge disparity. 

00:05:24 Prof Leonard Egede 

On average, obviously they are rich black people. They are rich Hispanic people going on average for population level. White households actually have more income than black households. So if you're thinking about the concept of who will benefit from. 

00:05:38 Prof Leonard Egede 

Income, supplementation and maybe universal basic income is obviously households that are relatively poor. And so we would actually say it is not so much because there are white houses are also poor. A lot of these programs are designed for people who live below a certain income level, regardless of your race or your ethnicity. 

00:05:59 Will Mountford 

And to tie this into what we covered in the previous episode with diabetes in your research as a particular example. 

00:06:05 Will Mountford 

Could you tell me where does diabetes fit in terms of the US health economic landscape? 

00:06:10 Prof Leonard Egede 

Yeah. So diabetes is also a disease that is two things. It's actually tied to poverty because most of the dietary requirements are healthy food cost money. Diabetes is also very expensive. And so in terms of cost of taking care of buying medication, buying supplies. 

00:06:25 Prof Leonard Egede 

But then also neighborhood. So the ability to have a place you can walk around, you can actually exercise is also tighter income. So people who are lower income tend to live in concentrated with concentrated poverty tend to live in neighborhoods, are not safe, so they can't exercise, they can't walk around. 

00:06:40 Prof Leonard Egede 

And they probably don't have grocery stores that are already available, so healthy foods are not an option. So income has a huge impact to play on diabetes and diabetes outcomes and individuals who are lower income segments tend to have a disadvantage in multi at multiple levels including, like I said, access to care, being able to afford insurance. 

00:07:00 Prof Leonard Egede 

Being able to have good doctors, good treatments, access to healthy foods, access to housing, access to safe neighborhoods, all of those factors, which are all detrimental to diabetes outcomes. 

00:07:13 Will Mountford 

And in terms of the burden in the previous episode, we mentioned that diabetes affects 13% of the US population generally. What does that look like in dollar values? 

00:07:22 Prof Leonard Egede 

Yeah. So I think as you look at the economic, I'm just going to reference kind of the week. There's a recent paper that just came out that looked at the cost of diabetes in 2022. And so that is called economic cost of diabetes in 2022. This is published so often by the in diabetes care and it summarizes data and looks at cost of diabetes. And when you look at. 

00:07:44 Prof Leonard Egede 

The overall cost of diabetes in 2022 in the US, it costs about four. 

00:07:49 Prof Leonard Egede 

$112 billion of that, about 306 billion, is direct medical cost and 106 billion is indirect cost. 

00:08:00 Prof Leonard Egede 

It does shows that for people diagnosed with diabetes, about one in four healthcare dollars in the US is tied to diabetes and about 61% of that cost is attributable to diabetes. So diabetes has a huge impact on cost. 

00:08:15 Prof Leonard Egede 

And then we look at the annual expenditure for individuals with diabetes, individuals with diabetes in cure medical expenditures of roughly about 20,000 per year and then approximately 12 of that alone, 12,000 of that alone is due to diabetes. 

00:08:31 Prof Leonard Egede 

And then we look at medical expenditures. Individuals with diabetes have on average about almost three times higher cost. 

00:08:38 Prof Leonard Egede 

Compared to individuals without diabetes, so again you see that diabetes is a huge driver of cost of healthcare, but the other part of it is because of the disability that's due to diabetes, you have reduced employment due to diabetes, you have lost productivity or premature deaths and so roughly about 32 billion of that. 

00:08:58 Prof Leonard Egede 

So the cause is due to lost productivity. People can't work, they can't get to work because of the underlying diabetes. 

00:09:05 Will Mountford 

That touches on my next question of insulin costs being something that have been discussed as a kind of a major problem for the diabetic population in terms of a healthcare cost burden. What kind of percentage of that burden is made-up just in terms of a preventative medicine like insulin, if there's any kind of data that can say? 

00:09:26 Will Mountford 

Here is the monthly cost of insulin. Here is how that looks is an annual sum. 

00:09:31 Prof Leonard Egede 

Yeah. So I think when you look at the cost of in terms of millions of dollars or in terms of average cost, so insulin is actually one of the most expensive medications that we actually have because it's very effective, a lot of individuals use it. We obviously have newer medications now that cost just as much, right. And so when you look. 

00:09:50 Prof Leonard Egede 

At the data from. 

00:09:51 Prof Leonard Egede 

Roughly, the 2022 estimates the average cost of insulin is roughly about $22,000 a year for people to actually pay for insulin. So that's a lot of cost. And we look at the total cost in terms of. 

00:10:04 Prof Leonard Egede 

Of the average cost per individual, installing the loan accounts over $22,000 of average cost for the individuals. So for those who want insulin. And then when you look at in terms of medications, again, you're looking at roughly just medications alone is roughly about $631 million. 

00:10:25 Prof Leonard Egede 

That gives you a sense of how much money medications actually cost for diabetes, and that's why if you don't have insurance or you're not able to afford this, I mean, that's just huge, huge cost. 

00:10:39 Will Mountford 

I mean, there's the ongoing discussion and shifting policy around the price cap on insulin and we can skip this something that's not necessarily reflected in your research of do you see that as being something that is having any impact on the cost and health burdens? 

00:10:57 Prof Leonard Egede 

Absolutely. I think, I mean obviously we this has just been introduced, there was legislation that was introduced. 

00:11:03 Prof Leonard Egede 

And many of the pharmaceutical companies are now on board with trying to set a reasonable price for insulin. I think that's gonna have the major impact, especially for lower income individuals or those who are not, who are not insured because the cost, even those who have insurance, they co-pays, which is the extra money to pay out of pocket by lowering the cost, that will actually help those individuals be able to afford medications. 

00:11:24 Will Mountford 

Because without that CAP and without that assistance, I mean, is there an income threshold? Is there a annual salary per year at which diabetes moves from being a condition that you can live with to a health concern? Because, I mean, I've seen anecdotes of. 

00:11:40 Will Mountford 

People dying due to diabetic complications because they've been trying to ration their insulin because they cannot keep up with payments that. 

00:11:47 Prof Leonard Egede 

Sort of thing. Yeah, I think regardless of your income level. 

00:11:52 Prof Leonard Egede 

Diabetes is expensive and it's a function of so there are multiple factors that come into play, whether you have complications, how many hospital stays you have. So if you have to spend your time in the hospital, your cost increases exponentially. It goes from just the average cost we describe to huge expenses if you have. 

00:12:12 Prof Leonard Egede 

Versus not having insurance. That makes a huge difference then depends on how severe your disease is. So if you're early on in the disease versus later on in the disease more complicated. So I think across the board, diabetes is expensive regardless of the income level, but below a certain income level like you're describing, it literally becomes a survival issue. 

00:12:32 Prof Leonard Egede 

70% of bankruptcies Are due to health related costs where people can pay their cost. So you can imagine if you're below the median income level. So if you're making less than 50,000 a year and you have diabetes, it's going to be very, very challenging. Pay for your care to cover the test strips the things that are needed for managing diabetes and it makes it really difficult. 

00:13:00 Will Mountford 

I mean, money does outsource a lot of the problems that come with it, but. 

00:13:04 Will Mountford 

Is there any assurance that people can have from? I mean, we're gonna get into some of the financial incentive trials going forwards, but. 

00:13:12 Will Mountford 

To kind of reflect on what we've covered so far, what do maybe policymakers need to know about how expensive it is to be poor and then we can get on to the financial incentive trials as here are suggested fixes here are suggested solutions. 

00:13:27 Prof Leonard Egede 

Yeah. One of the things we don't do a very good job at on the research and clinical side is we actually don't. 

00:13:34 Prof Leonard Egede 

Distill information so that policymakers can have a better sense of what it means. You know, in most policy for individuals, legislators are not going to read a full-fledged paper. They're unlikely to see now. Maybe they have their legislative staff review it. And so the more we're able to use visuals, things like graphic abstracts where people can quickly. 

00:13:54 Prof Leonard Egede 

Quick snapshot get information. I think that's gonna help, but more importantly, I think being able to. 

00:14:00 Prof Leonard Egede 

Create data that summarizes cost in a way you know. So what I just did was I put data from a large publication right. I believe that you digest that information and say to people, here's what we're really talking about. Here's what an average individual with diabetes cost about 22,000 versus someone who doesn't have diabetes and that type of. 

00:14:20 Prof Leonard Egede 

Information is gonna actually help policymakers, but I also think that if there's one message, the message is that diabetes is. 

00:14:29 Prof Leonard Egede 

It's highly prevalent, it's expensive, and the more we are able to increase access to healthcare, access to health insurance, that is going to actually go a long way to covering the. 

00:14:39 Prof Leonard Egede 

Cost of diabetes. 

00:14:41 Will Mountford 

Well, as a clinical trial in terms of public health initiatives and I mean it feels weird to use money as a medication effectively. Could you talk me through some of the trials that have been put in place for financial incentives? What has been previously deployed, what shows promise and if there's anything that is working particularly well? 

00:15:02 Prof Leonard Egede 

I will walk backwards and talk about cause. Like I said, there are three areas we are studying right now. One is universal basic income. Two is income supplementation and the third is actually incentives. So the two that are very critical because those are where a lot of the policy issues are going to drive are universal basic income. 

00:15:22 Prof Leonard Egede 

And income supplementation, because incentives, people can get incentives. Let me just talk about each of these studies that we've actually done. The first one is Universal basic income. We have a member of our team where we are actually saying if we took people who are low income with diabetes, who are living below the poverty line with diabetes. 

00:15:39 Prof Leonard Egede 

And we actually gave them monthly income of $500. 

00:15:44 Prof Leonard Egede 

And that $500 is ideally designed to offset a lot of the cost of the things they have to deal with in the context of those funds, there's something called conditional and unconditional conditional means that it's conditional on them doing something. In this case, we're asking them to attend. 

00:16:01 Prof Leonard Egede 

Every two weeks attend the diabetes education session at the end of the month. If they attend the sessions, they get the $500, whereas unconditional is that they get the money regardless of whatever they do. And our goal is to see whether making a conditional unconditional will have an impact on diabetes outcomes. The goal is to recruit 100 individuals. 

00:16:20 Prof Leonard Egede 

50 and 50 in each group we're going to test this over a period of time to see if it makes a difference. We've actually completed recruitment for that study. 

00:16:30 Prof Leonard Egede 

And we're now in the follow up phase, but a couple of things. We've actually observed. One of the challenges of criticisms of basic income is the idea that if you give people money, they may use for drugs, they may use it for things that are not meant to use it for we have looked at data from that study. So far, 97% of individuals in the study use the funds for things like. 

00:16:50 Prof Leonard Egede 

Transportation, food. So it's being used for what it was designed to be used and the other 3% we don't have enough clarity to know what it was used for. But we have not seen any situation where it was just being used for illegal substances or drugs. So that's the key part. And then the participation has been virtually almost 100%. We actually had more slots. We have more people. 

00:17:11 Prof Leonard Egede 

Looking for slots and these slots where you have available to give them, so there's obviously there's. 

00:17:15 Prof Leonard Egede 

Strong interest now we've not analyzed the data yet, we're going to be doing that shortly to actually look at in the next year or so to look at what does this really do because the next step now is to take that to a larger study to now look at low cause. This current study six months, our goal is to eventually demonstrate that this works and then test it in a larger sample for a 12 month period and then we can then begin to make. 

00:17:35 Prof Leonard Egede 

Recommendations about how to use Universal basic income. 

00:17:39 Will Mountford 

Right. And with the people that have signed up to participate so far, how much consideration is given to the ethnic component in that? 

00:17:48 Prof Leonard Egede 

Yeah. So this particular study right now is focused on minority groups. And so we're really focused on minority groups because we wanted to go to the highest risk group. But we intend after the this initial pilot phase to actually open it up to all groups regardless of race, but more focused on their income. 

00:18:04 Prof Leonard Egede 

I will and see if we're gonna. 

00:18:06 Prof Leonard Egede 

Get the same results. 

00:18:07 Will Mountford 

When it comes to the reporting of that you mentioned, you've gathered data for both groups, the adherent and the kind of non monitored. 

00:18:15 Will Mountford 

How are people participating in giving that information in if they have to turn up in person? Because I imagine that the pandemic had a lot of influence on how willing people were to go to hospitals to go to medical facilities. 

00:18:29 Prof Leonard Egede 

So we have used a combination of in person and virtual. We find some things away. So for example the educational component, we actually do virtual for most of our studies. We have either for telephone or some form of video conference. 

00:18:42 Prof Leonard Egede 

We've tried. We've found that. Then the other option we actually use is going to people's homes because many times transportation coming in is actually challenges. We actually go to them and we find that that is actually very helpful in terms of engagement, especially for minority populations, for low income populations that it eases the burden of trying to get to us. 

00:19:01 Prof Leonard Egede 

When we actually go to them, but in some situations for things like the blood draws for things like the survey administration, we actually will have people come to us. So we do a mix of virtual in person and then we go to their homes or they come to us and that's kind of what. 

00:19:16 Prof Leonard Egede 

Yes, obviously there's very strong evidence that remote areas had to reach areas which are using telehealth makes a huge difference. So that's a whole different conversation. But what I want to also do and make sure we don't miss out is the other two studies that cover the spectrum of income we just talked about, one which is the universal basic income. 

00:19:36 Prof Leonard Egede 

The second is the study we're doing on income supplementation. So in this case, we're taking food insecure individuals. We're randomizing 150 individuals who are food insecure, who after two diabetes and we are assigning them to three different groups of 50 each. One group gets education. 

00:19:53 Prof Leonard Egede 

They get diabetes education and that's all they're getting. The second group gets diabetes education, but they also get income supplementation. We supplement their income by $100 every month to help them offset cost of food and things like that. And then the third group get the income, supplementation, education, but they also get additional incentives. 

00:20:13 Prof Leonard Egede 

If they buy healthy food. 

00:20:14 Prof Leonard Egede 

So they get a certain amount of money every month. If that issue receipt and they can fax the receipt so they can scan it, they can e-mail it and if they demonstrate they actually bought out before they get and again that study we've actually completed randomizations. We've actually recruited everyone it is 6 month follow up and so far the feedback we we haven't analyzed the data yet but the feedback we've gotten from participants. 

00:20:35 Prof Leonard Egede 

It's it's very, very helpful. It's really helping them navigate some of the financial challenges they're facing and they are, we are very optimistic that if this works out well, then we can actually do a bigger study to actually then test what are the optimal ranges of. 

00:20:50 Prof Leonard Egede 

No, I think the only thing I want to add is the concept of the. So I talked about three different financial incentive programs, we talked about Universal basic income, we talked about income, supplementation, the one study I didn't cover is the one on the actual incentives and that's a study that we actually did where we took 60 individuals we actually. 

00:21:09 Prof Leonard Egede 

Assign them to three different incentive structure. 

00:21:12 Prof Leonard Egede 

The first incentive structure was dosed. They actually got. They were given $300.00 at the end of three months. If they just took care of their diabetes. The second group got half of that incentive, 150 if they attended diabetes education classes and the other 150 if they actually got their A1C or their diabetes controlled at three months. 

00:21:32 Prof Leonard Egede 

And then the third group got a third of the amount for attending classes, 1/3 for monitoring the glucose at home and uploading the readings and getting good results. And then the third for lowering your they're achieving diabetes control. And what we found was in those. 

00:21:47 Prof Leonard Egede 

Three arms and we saw a significant drop in diabetes control or improvement in diabetes control. We we use hemoglobin A1C as a measure in all my research to date. If we get a 1% drop in A1C, we are excited many of the drug trials will drop A1C by 1 1/2 points. We found between 1.7. 

00:22:07 Prof Leonard Egede 

Drop to two almost A2 fold drop. 

00:22:10 Prof Leonard Egede 

In a 12 point drop, so 1.7 to two points with the very significant drop. So we use that to then get a federal grant, right. And it's almost wrapping up where we actually randomizing 450 individuals to this intervention across racial groups and it the goal is to one does this winner expand to 18 months, we're doing 12 months at 12 months. We stopped the incentives. 

00:22:31 Prof Leonard Egede 

And we then follow them for six additional months to see if something is then if one at 12 months do they get better then at six months after that if you stop the incentives, will people move from extrinsic motivation as all financial to intrinsic which is based on their own internal? 

00:22:47 Prof Leonard Egede 

Work, but we also separated them into three racial groups, non Hispanic wives, Hispanic and then African Americans. And the goal is to see whether the incentives work differently for different racial groups. And so that study were done with recruitment. Right now we're in that follow up phase. We should start analyzing results by the end of this year. We'll have some initial results to see. Will this make a huge difference that's going to be a game. 

00:23:08 Prof Leonard Egede 

Danger in terms of how we leverage incentives. 

00:23:15 Will Mountford 

So the question then you mentioned the expansion hopefully coming down the line would be, what would the timeline look like in an ideal world to get from? 

00:23:26 Will Mountford 

These initial studies, these pilot investigations to that larger study to then what city? State nationwide. 

00:23:33 Prof Leonard Egede 

Yeah. So usually we're trying to accelerate these grants and these processes. So we actually have a pending grant that will allow us to do this in a larger sample. We're going to go to a larger sample for 12 months. And so ideally 3 years out, we should have enough data. 

00:23:51 Prof Leonard Egede 

To suggest that this is so that we can actually then pitch to policymakers to Medicare, Medicaid and fund, that is to say, look, this is a viable option cause the issue is not, it's always the question is, will this work? And then after you show that it works then will it work for different populations, who is going to benefit from it? We won't have enough data to actually demonstrate that for different groups. 

00:24:12 Prof Leonard Egede 

This actually works well. 

00:24:13 Will Mountford 

I mean, without necessarily wanting to get into a political discussion about this, just in the sort of written in the outline here are financial incentives, a success story or are they just catching up to where other countries have universal healthcare by other means? 

00:24:29 Prof Leonard Egede 

I'll say that let's let's address the politics. I think there's a lot of conversation about that politicizes health and health and which is one of my I've said this over and over again that our health is not about politics, it's about lives and people and the importance of making sure that everyone has a chance to have a healthy life. I think the. 

00:24:49 Prof Leonard Egede 

Incentives is not a politics conversation. It's about rational evidence. The evidence suggests that if you give people incense. 

00:24:59 Prof Leonard Egede 

Yes, they did better if they did, better healthcare costs less. The inpatient stays are lower. Mortality rates go down. If that is true, then it is not a politics conversation. It's a rational healthcare business decision. And so the way I tend to look at this and I really want us to begin to think about this is not to spend a lot of time. 

00:25:22 Prof Leonard Egede 

Thinking about the politics, because politics is subjective, people feel certain ways. 

00:25:27 Prof Leonard Egede 

But I think we are trying to generate evidence to change policy to actually say if you did this, this is how much it will cost you to deliver this intervention. 

00:25:36 Prof Leonard Egede 

This is how much benefit you're going to get, and if you do, the cost benefit analysis, you're gonna find that giving incentives is actually beneficial and it actually cost less if that is the case, then the rational logical thing to do is to give incentives. 

00:25:52 Will Mountford 

It would be nice to believe that rational, sensible policy and rational, sensible business was behind a lot of the policy that is affecting public health, at least in the UK. Fingers crossed that that kind of evidence and impact does come together. 

00:26:09 Will Mountford 

So as a kind of summary to wrap up everything that we've covered so far, we've mentioned the policymaker take away, but for the kind of the peer and patient people listening to this who will be. 

00:26:19 Will Mountford 

Wanting to know what can I ask my doctor or what can I ask my healthcare provider as? 

00:26:28 Will Mountford 

You know something to help my diabetes costs or to help my patients who are reporting that they can't make it into the clinic because they are unwell, so they can't come get their shots. Is there anything that people can take away from what we're talking about to say that change is coming, that there might be trials opening near them soon? 

00:26:45 Prof Leonard Egede 

Yes, absolutely. I think at the patient level at the individual level, I think we are very optimistic that one, this is a more openness to these types of studies. There's more funding coming in for these types of studies and they're going to be more trials available for participants and most patients now you can go to clinicaltrials.gov  

00:27:05 Prof Leonard Egede 

in the US, you can actually identify studies that are at your open and recruiting your neighborhood and being able to actually identify those studies and being involved at least helps generate that body of evidence. But then also, as patients, you are taxpayers, you have a right to lobby. 

00:27:20 Prof Leonard Egede 

We can lobby cause we do research, right? But individuals who have access to the evidence can actually talk to their legislators and say, you know, are you willing to entertain this idea? Are you willing to support these types of programs and ensuring that we're not asking for people to do things? We're actually asking to follow the evidence and let the evidence actually be used in a way that's objective. 

00:27:41 Prof Leonard Egede 

So that's where the individual can come. 

00:27:44 Prof Leonard Egede 

Now for physicians, obviously, physicians have a role to play and one of the things as physicians and healthcare providers is to check your biases. I think there are many people who have a fundamental bias against incentives. Their idea is why should we give money to people to change behavior? They should change behavior. And the fact is the psychological evidence, the wealth of evidence to. 

00:28:03 Prof Leonard Egede 

Yes, the incentives drive behavior change. We've seen it for smoking situation. We see it for weight loss. So there's no reason why it wouldn't work for diabetes. And evidence suggests right now that it works for diabetes. So I think for the healthcare providers, it's one to check their buyers and be open to the possibility of this being a new way of maximizing care and ensuring. 

00:28:23 Prof Leonard Egede 

That patients get good outcomes. And then finally for the insurance again being open to the. 

00:28:28 Prof Leonard Egede 

This, you know, we spend a lot of time as in the healthcare system telling people what to do and we should be more open to things that actually are different from what you call this done and maybe new ways of approaching the same problem, new ways of investing resources and leveraging those resources in a way that maximizes optimal health. 

00:28:46 Will Mountford 

And if anyone listening to this wants to find more from either your papers and publications or more from your research, is there anything that we can send to them to say that this is the website, come here to read your work. 

00:28:57 Prof Leonard Egede 

Yeah. So I think what we can actually do is we're going to have a compilation of the different papers so that people can actually be linked with. They can actually go to and identify those papers. They usually all available publicly available on the NIH site. But we can actually provide the links so people can go look for these studies. 

00:29:14 Will Mountford 

Professor Egede, thank you again so much for your time and I look forward to speaking with you again soon. 

00:29:17 Prof Leonard Egede 

All right. Thank you so much. Have a good rest of your day. 

00:29:20 Will Mountford 

Thank you.