UC Berkeley

I examine medical adherence among patients and health care providers. Non-adherence is common throughout health care: providers frequently do not follow clinical practice guidelines, and patients often do not take their prescribed treatments. These behaviors are widespread and highly consequential: in a given year in the United States alone, it is estimated that diagnostic errors lead to 40,000 to 80,000 deaths, and patient non-adherence to medication leads to $300 billion in preventable health care costs. For these reasons, the World Health Organization has stated that “increasing adherence may have a greater effect on health than improvements in specific medical therapy”. Using data from Chile's public, primary health care system I first show that sending reminders to patients with chronic conditions can improve health-seeking behavior. Through nudging patients at the beginning of the cascade of care, preventative care visit reminders increase not only visits but also testing, medication adherence, and tertiary care utilization. In the second paper I show that healthcare providers deviate from clinical practice guidelines, using discretion to make diagnostic and treatment decisions about hypertension. This behavior leads to a more accurate sorting of patients on either side of the diagnostic threshold, and ultimately benefits patients through avoiding unnecessary diagnoses.