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The use of behavioral insights and experimental methods has recently gained momentum among health policy-makers. There is a tendency, however, to reduce behavioral insights applications in health to “nudges,” and to reduce experiments in health to “randomized controlled trials” (RCTs). We argue that there is much more to behavioral insights and experimental methods in health economics than just nudges and RCTs. First, there is a broad and rich array of complementary experimental methods spanning the lab to the field, and all of them could prove useful in health economics. Second, there are a host of challenges in health economics, policy, and management where the application of behavioral insights and experimental methods is timely and highly promising. We illustrate this point by describing applications of experimental methods and behavioral insights to one specific topic of fundamental relevance for health research and policy: the experimental elicitation and econometric estimation of risk and time preferences. We start by reviewing the main methods of measuring risk and time preferences in health. We then focus on the “behavioral econometrics” approach to jointly elicit and estimate risk and time preferences, and we illustrate its state-of-the-art applications to health.

Empirical studies show that years of schooling are positively correlated with good health. The implication may go from education to health, from health to education, or from factors that influence both variables. We formalize a model that determines an individual’s demand for knowledge and health based on the causal effects, and study the impacts on the individual’s decisions of policy instruments such as subsidies on medical care, subsidizing schooling, income tax reduction, lump-sum transfers, and improving health at young age. Our results indicate that income redistribution policies may be the best instrument to improve welfare, while a medical care subsidy is the best instrument for longevity. Subsidies to medical care or education would require large imperfections in these markets to be more welfare improving than distributional policies.

There is considerable heterogeneity between primary care systems that have evolved in individual national cultural environments. Models of Child Health Appraised (MOCHA) studied how the transfer of models or their individual components can be achieved across nations, using examples of combinations of settings, functions, target groups and tracer conditions. There are many factors that determine the feasibility of successful transfer of these from one setting to another, which must be recognised and taken into account. These include the environment of the care system, national policy-making and contextual means of directing population behaviour – in the form of penalties and incentives, which cannot be assessed or expected to work by means of rational actions alone. MOCHA developed a list of criteria to assess transferability, summarised in a population characteristics, intervention content, environment and transfer (PIET-T) process. To explore the process and means of transferability, we obtained consensus statements from the researchers on optimum model scenarios and conducted a survey of stakeholders, professionals and users of children’s primary care services that involved three specific health topics: vaccination coverage in infants, monitoring of a chronic or complex condition and early recognition of mental health problems. The results give insight into features of transferability – such as the availability and the use of guidelines and formal procedures; the barriers and facilitators of implementation and similarities and differences between model practices and the existing model of child primary care in the country. We found that successful transfer of an optimal model is impossible without tailoring the model to a specific country setting. It is vital to be aware of the sensitivity of the population and environmental characteristics of a country before starting to change the system of primary care.

Adolescence is a time when a young person develops his or her identity, acquires greater autonomy and independence, experiments and takes risks and grows mentally and physically. To successfully navigate these changes, an accessible and health system when needed is essential.

We assessed the structure and content of national primary care services against these standards in the field of adolescent health services. The main criteria identified by adolescents as important for primary care are as follows: accessibility, staff attitude, communication in all its forms, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community.

We found that although half of the Models of Child Health Appraised countries have adopted adolescent-specific policies or guidelines, many countries do not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care or respond to life-threatening behaviour is limited. Many countries provide good access to contraception, but specialised care for a pregnant adolescent may be hard to find.

Access needs to be improved for vulnerable adolescents; greater advocacy should be given to adolescent health and the promotion of good health habits. Adolescent health services should be well publicised, and adolescents need to feel empowered to access them.

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

Models of Child Health Appraised (MOCHA) defines school health services (SHSs) as those that exist due to a formal arrangement between educational institutions and primary health care. SHSs are unique in that they are designed exclusively to address the needs of children and adolescents in this age group and setting.

We investigated SHSs have been provided to schools and how they contribute to primary healthcare services for school children. We did this by mapping the national school health systems against the standards of the World Health Organization, and against a framework measuring the strength of primary care, adapting this from an existing, adult-focused framework.

We found that all but two countries in the European Union and European Economic Area have SHSs. There, however, remains a need for much greater investment in the professional workforce to run the services, including training to ensure appropriateness and acceptability to young people. Greater collaboration between SHSs and primary care services would lead to better coordination and the potential for better health (and educational) outcomes. Involving young people and families in the design of SHSs and as participants in its outputs would also improve school health.

This paper attempts to understand how the interaction of natural disasters and human behaviour during wartime led to famines in three regions under imperial control around the Indian Ocean. The socio-economic structure of these regions had been increasingly differentiated over the period of imperial rule, with large proportions of their populations relying on agricultural labour for their subsistence.

Before the war, food crises in each of the regions had been met by the private importation of grain from national or overseas surplus regions: the grain had been made available through a range of systems, the most complex of which was the Bengal Famine Code in which the able-bodied had to work before receiving money to buy food in the market.

During the Second World War, the loss of control of normal sources of imported grain, the destruction of shipping in the Indian Ocean (by both sides) and the military demands on internal transport systems prevented the use of traditional famine responses when natural events affected grain supply in each of the regions. These circumstances drew the governments into attempts to control their own grain markets.

The food crises raised complex ethical and practical issues for the governments charged with their solution. The most significant of these was that the British Government could have attempted to ship wheat to Bengal but, having lost naval control of the Indian Ocean in 1942 and needing warships in the Atlantic and Mediterranean in 1943 chose to ignore the needs of the people of Bengal, focussing instead on winning the war.

In each of the regions governments allowed/encouraged the balkanisation of the grain supply – at times down to the sub-district level – which at times served to produce waste and corruption, and opened the way for black markets as various groups (inside and outside government ranks) manipulated the local supply.

People were affected in different ways by the changes brought about by the war: some benefitted if their role was important to the war-effort; others suffered. The effect of this was multiplied by the way each government ‘solved’ its financial problems by – in essence – printing money.

Because of the natural events of the period, there would have been food crises in these regions without World War II, but decisions made in the light of wartime exigencies and opportunities turned crises into famines, causing the loss of millions of lives.