Smarter Choices for Better Health

Healthcare expenditures are increasing rapidly. This minor uses insights from behavioural and health economics to study how these expenses can be made more efficiently. It does so by using different perspectives: individual and organisational in the main course, and hospital, national and global perspectives on health and behaviour in the electives.

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Good health care is essential for a long and healthy life. A lot of progress has been made in recent decades, but many countries still face huge challenges when it comes to funding and delivering high quality health care. On average, health and life expectancy have improved, but there are large differences between and also within demographic groups. Lifestyle and preventive measures play an important role in this context. Academics from the disciplines of health economics, behavioural economics, public health care and global health are joining forces to make health care systems fairer and more effective with the existing financial resources. The results of this research will be reflected in this minor.

This 30 EC minor comprises of four modules: one large introductory module of 15 EC, which can also be chosen as a 15 EC minor (course code GWMINOR323), and three elective courses of 5 EC each of Erasmus School of Health Policy & Management.

The introductory module Analysing and Changing Unhealthy Behaviour (ACUB) ), which also comprises the SCBH 15 EC variant, uses a micro perspective to show how healthy behaviour can be stimulated. One of the components of this introductory minor is to design a health intervention. In addition, the students deepen their knowledge in three smaller modules. The module Value Based Healthcare (VBHC) applies a hospital perspective, focusing on maximising the value and minimising the costs of care delivery. The module Rationing: economic insights in rationing healthcare (RHC) uses behavioural economics to study the allocation of healthcare resources from a country perspective, including examples from different countries. Finally, the module Global Challenges in Health Behaviour (GCHB) adapts a global health perspective, with a focus on strengthening health care systems in low- and middle-income countries.

• Can explain and apply the traditional economic approach to rational choice, and discuss the merits and limitations of this approach for understanding and changing behaviour.
• Can apply basic economic and mathematical tools to demonstrate and/or explain how traditional assumptions about rationality are violated (e.g. using behavioural models).
• Are able to give examples of heuristics and biases in intertemporal choice, risky choice and social choice.
• Can apply these behavioural insights to understand and analyse health behaviour, in at least two settings: lifestyle choice, and patient and physician decision-making.
• Differentiate between, provide arguments for and against, discuss challenges, and give examples of appropriate applications in health for the following five common (policy) interventions: a) nudging, b) boosting, c) (financial) incentives, d) taxation/regulation and e) information provision.
• Are capable of applying insights from behavioural and health economics to develop and evaluate an intervention aimed at promoting health and/or wellbeing.
• Can design and implement their own survey, experiment or intervention on a behavioural health topic.
• Are able to perform sound quantitative scientific research and report it in a paper.
• Can explain the main concepts behind and criticisms on VBHC theory.
• Are familiar with some of the current initiatives to implement VBHC, in the Netherlands and internationally.
• Understand Integrated practice units - integrating care paths at level of medical condition and recognize how IPUs compare and contrast to other forms of integrated care.
• Understand the basic principles behind Shared Decision Making (SDM), and how SDM and decision aids are linked to VBHC.
• Can reproduce the main practical advantages and disadvantages of VBHC.
• Understand what are the (dis)advantages and main methodological issues when benchmarking outcomes between health care providers.
• Can explain the main drivers of provider payment reform in health care.
• Can describe the key features of different value-based payment methods.
• Are able to derive lessons from initiatives with value-based payment in practice, and formulate future challenges.
• Have obtained a thorough understanding of rationing health care from an economic perspective and can critically reflect on the advantages and disadvantages of demand and supply side rationing (in different countries).
• Understand worldwide challenges related to health, health care systems and health behaviours as well as policy interventions to reduce these, especially in low- and middle-income countries.
• Are able to evaluate and critically reflect on a quantitative research method as applied in a scientific study on health, unhealthy behaviour and/or a related policy intervention.
• Can create, give and provide feedback on a presentation about a scientific study related to health, health care systems and/or behaviour to peers, as well as generate questions about the content of that scientific article.

We expect students that enroll for the minor Smarter Choices for Better Health (MINESHPM223) to follow the full 30 EC program. If you only wish to follow a 15 EC minor, please enroll for the minor Analysing and Changing Unhealthy Behaviour (MINESHPM323).

The lectures and working groups finish before the Christmas break and all take place on campus.

No prior knowledge is required, although the minor is entirely taught in English and, hence, good command of English is beneficial.

For the ACUB - SCBH (15EC) module, applying insights from health and behavioural economics will often involve the use of algebra and calculus. In this course, this will involve exercises requiring the equivalent of high school math skills. Nonetheless, there are no entry requirements, and material will be available at the start and during the course for students to acquire these skills.

Attendance and active participation are mandatory for some of the minor modules.

Modules

1. Analysing and changing unhealthy behaviour (ACUB)
2. Value based Based Health Care (VBHC)
3. Rationing: economic insights in rationing healthcare (RHC)
4. Global Challenges in Health & Behaviour (GCHB)

**Teaching methods

Analysing and changing unhealthy behaviour (ACUB) - SCBH (15EC):** All lectures and work groups for this course will in principle take place in person and on campus. Each week will have several interactive lectures and working groups, in which students will work individually and in groups on cases specific to the learning goal of that week. For example, by analysing a specific health behaviour using the new knowledge covered in the lectures, or by debating positions on different policies for health behaviour change. Throughout the minor, students develop a portfolio that includes their weekly reflection on the covered material in various forms (e.g., short essay, slides, or vlog). Furthermore, they will apply an existing behavioural insights toolkit to a case to develop an intervention which is also presented to other students and teachers.

Value based Based Health Care (VBHC): (Guest)lectures and 4 interactive working groups on campus.
Global Challenges in Health & Behaviour (GCHB): Short lectures combined with student presentations and training about presentation skills. Small groups or pairs of students will present a scientific paper and receive peer-feedback from fellow students. This will all take place on campus.
Rationing Health Care: (Guest) lectures and practice sessions on campus.

**Materials

Analysing and changing unhealthy behaviour (ACUB) - SCBH (15EC):** The teaching materials will be a selection of journal articles and book chapters. Suggestions for additional reading (mainly popular science books) will be offered during the course. Several case studies are discussed during the working groups, and students work on a case and intervention during the later weeks of the minor.

Value based Based Health Care (VBHC): Journal articles
Global Challenges in Health & Behaviour (GCHB): Journal articles
Rationing Health Care: Selection of book chapters and journal articles

Examination

The examination of the different modules is as follows:
Analysing and changing unhealthy behaviour (ACUB) - SCBH (15EC): Combination of a written exam, portfolio excercises and intervention report.
Value based Based Health Care (VBHC): Written exam
Global Challenges in Health & Behaviour (GCHB): Presentation, providing feedback and participation
Rationing Health Care: Written exam

ACUB SCBH (15EC) : : The written exam counts for 50% of the grade. The portfolio with reflection exercises is worth 10% of the grade. The behavioural health intervention counts for 40% of the grade. To pass this course, students need a weighted average grade of 5.5 or higher, and get at least a 5.0 for each of the three parts. The written exam can be retaken later in the academic year, but the weekly portfolio exercises cannot. Students that receive a grade lower than 5.0 for the behavioural health intervention can hand in a resit intervention. The maximum grade for this resit intervention is a 6.0. Participation in weekly working groups is not mandatory but recommended to achieve the learning goals and successful completion of the weekly reflection in the portfolio.

VBHC: Composition final grade is determined bij written examination 100% and mandatory participation of the working groups. In order to obtain a "pass" for participation each student is expected to participate actively and to attend at least 3 of the 4 meetings.

RHC: 100% written exam

GCHB: Presentation of a scientific quantitative paper (55%), peer feedback (30%), participation (15%). All grades are given at an individual level, also for the presentations where students prepare in small groups/pairs.