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Self-Control and Demand for Preventive Health: Evidence from Hypertension in India

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  • Bai, Liang
  • Handel, Benjamin
  • Miguel, Edward
  • Rao, Gautam

Abstract

Self-control problems constitute a potential explanation for the underinvestment in preventive health in low-income countries. Behavioral economics offers a tool to solve such problems: commitment devices. We conduct a field experiment to evaluate the effectiveness of different types of theoretically motivated commitment contracts in increasing preventive doctor visits by hypertensive patients in rural India. Despite achieving high take-up of such contracts in some treatment arms, we find no effects on actual doctor visits or individual health outcomes. A substantial number of individuals pay for commitment but fail to follow through on the doctor visit, losing money without experiencing health benefits. We develop and structurally estimate a prespecified model of consumer behavior under present bias with varying levels of naiveté. The results are consistent with a large share of individuals being partially naive about their own self-control problems: sophisticated enough to demand some commitment but overly optimistic about whether a given level of commitment is sufficiently strong to be effective. The results suggest that commitment devices may in practice be welfare diminishing, at least in some contexts, and serve as a cautionary tale about their role in health care.

Suggested Citation

  • Bai, Liang & Handel, Benjamin & Miguel, Edward & Rao, Gautam, 2021. "Self-Control and Demand for Preventive Health: Evidence from Hypertension in India," Department of Economics, Working Paper Series qt3w3154kb, Department of Economics, Institute for Business and Economic Research, UC Berkeley.
    • Handle: RePEc:cdl:econwp:qt3w3154kb
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    References listed on IDEAS

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    1. Esther Duflo & Michael Kremer & Jonathan Robinson, 2011. "Nudging Farmers to Use Fertilizer: Theory and Experimental Evidence from Kenya," American Economic Review, American Economic Association, vol. 101(6), pages 2350-2390, October.
    2. James Andreoni & Michael Callen & Karrar Hussain & Muhammad Yasir Khan & Charles Sprenger, 2023. "Using Preference Estimates to Customize Incentives: An Application to Polio Vaccination Drives in Pakistan," Journal of the European Economic Association, European Economic Association, vol. 21(4), pages 1428-1477.
    3. Stefano DellaVigna & Ulrike Malmendier, 2004. "Contract Design and Self-Control: Theory and Evidence," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(2), pages 353-402.
    4. Matthew Rabin & Ted O'Donoghue, 1999. "Doing It Now or Later," American Economic Review, American Economic Association, vol. 89(1), pages 103-124, March.
    5. Paul Heidhues & Botond Kőszegi, 2009. "Futile Attempts at Self-Control," Journal of the European Economic Association, MIT Press, vol. 7(2-3), pages 423-434, 04-05.
    6. Xavier Giné & Dean Karlan & Jonathan Zinman, 2010. "Put Your Money Where Your Butt Is: A Commitment Contract for Smoking Cessation," American Economic Journal: Applied Economics, American Economic Association, vol. 2(4), pages 213-235, October.
    7. Frank Schilbach, 2019. "Alcohol and Self-Control: A Field Experiment in India," American Economic Review, American Economic Association, vol. 109(4), pages 1290-1322, April.
    8. Nava Ashraf & Dean Karlan & Wesley Yin, 2006. "Tying Odysseus to the Mast: Evidence From a Commitment Savings Product in the Philippines," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 121(2), pages 635-672.
    9. Benjamin R. Handel, 2013. "Adverse Selection and Inertia in Health Insurance Markets: When Nudging Hurts," American Economic Review, American Economic Association, vol. 103(7), pages 2643-2682, December.
    10. David Laibson, 1997. "Golden Eggs and Hyperbolic Discounting," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 112(2), pages 443-478.
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    Cited by:

    1. Cobb-Clark, Deborah A. & Dahmann, Sarah C. & Kamhöfer, Daniel A. & Schildberg-Hörisch, Hannah, 2024. "Sophistication about self-control," Journal of Public Economics, Elsevier, vol. 238(C).
    2. Westphal, Ryan, 2024. "People do not demand commitment devices because they might not work," Journal of Economic Behavior & Organization, Elsevier, vol. 228(C).
    3. Favaretti, Caterina & Pillai, Vasanthi Subramonia & McConnell, Margaret & Ali, Mohammed K. & Murthy, Seema & Chandrasekar, Adithi & Yan, Shirley D. & Sudharsanan, Nikkil, 2025. "Does bundling reminders with messages debunking misconceptions improve the demand for preventive health services? A randomized controlled trial among adults with hypertension in Punjab, India," Social Science & Medicine, Elsevier, vol. 373(C).
    4. Spika, Devon & Wickström Östervall, Linnea & Gerdtham, Ulf & Wengström, Erik, 2024. "Put a bet on it: Can self-funded commitment contracts curb fitness procrastination?," Journal of Health Economics, Elsevier, vol. 98(C).
    5. Alexander M. Danzer & Helen Zeidler, 2024. "Present Bias in Choices over Food and Money," Working Papers 239, Bavarian Graduate Program in Economics (BGPE).
    6. Bauer, Daniel & Lakdawalla, Darius & Reif, Julian, 2025. "Health risk and the value of life," Journal of Public Economics, Elsevier, vol. 245(C).
    7. Alexander M. Danzer & Helen Zeidler, 2024. "Present Bias in Choices over Food and Money," CESifo Working Paper Series 11454, CESifo.
    8. Lefebvre, Bertrand & Mukhopadhyay, Abhiroop & Ratra, Vastav, 2025. "Who bears the distance cost of public primary healthcare? Hypertension among the elderly in rural India," Social Science & Medicine, Elsevier, vol. 366(C).
    9. Danzer, Alexander M. & Zeidler, Helen, 2024. "Present Bias in Choices over Food and Money," IZA Discussion Papers 17415, Institute of Labor Economics (IZA).
    10. Woerner, Andrej, 2023. "Overcoming Time Inconsistency with a Matched Bet: Theory and Evidence from Exercising," VfS Annual Conference 2023 (Regensburg): Growth and the "sociale Frage" 277711, Verein für Socialpolitik / German Economic Association.
    11. Gallegos, Sebastian & Roseth, Benjamin & Cuesta, Ana & Sánchez, Mario, 2023. "Increasing the take-up of public health services: An at-scale experiment on digital government," Journal of Public Economics, Elsevier, vol. 227(C).

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