DOI :10.26650/B/SS10.2024.013.004   IUP :10.26650/B/SS10.2024.013.004    Full Text (PDF)

Nudging in Behavioral Development Economics: an Evaluation of Preventive Health Services in Türki̇ye

Hatime Kamilçelebi

The well-being effects of human health on the economy are undeniable. While health affects people’s productivity and income in the short and long term, preventive health policies prevent an increase in health expenditures. However, some individuals experience limited access to health services due to living and economic conditions and may not have enough information about preventive health services. Even if they have information, they may procrastinate using these services for various economic, social, or psychological reasons. Behavioral economic development experiments related to the health of individuals living in rural areas of developing countries and developed countries are done. In these scientific studies, individuals are nudged to get vaccinated, screened, use preventive drugs, etc., through incentives or persuasive tools. After these methods were applied, it was revealed that most individuals paid more attention to their health than they had before. The aim of this study was to 1) emphasize the need to inform individuals about preventive health services associated with cancer in Türkiye, 2) make suggestions on how to reach people who could benefit from professional health services, and 3) provide guidance to health professionals. The aim to improve preventive health policies in Turkiye, which is one of the sustainable development goals of the United Nations, was considered, and the nudge and incentive studies carried out around the world were used as the basis for the research. With the implementation of these recommendations by policymakers, it is predicted that life expectancy would be extended, the quality of life would be better and health expenditures would decrease. In this study, the evaluations and suggestions are presented in this context.


  • Beraldo, S., & Karpus, J. (2021). Nudging to donate organs: do what you like or like what we do?. Medicine, health care, andphilosophy, 24(3), 329-340. google scholar
  • Balsa, A. I., & McGuire, T. G. (2003). Prejudice, clinical uncertainty and stereotyping as sources of health disparities. Journal of health economics, 22(1), 89-116. google scholar
  • Banerjee, A. V., Duflo, E., Glennerster, R., & Kothari, D. (2010). Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incenti-ves. BMJ (Clinical research ed.), 340, c2220. google scholar
  • Banerjee A. V., & Duflo, E. (2011). Poor economics: A radical rethinking of the way to fight global poverty. USA: PublicAffairs. google scholar
  • CAH Health. (2020). A comprehensive approach to changing health behaviors: Care, prevention and finance. CAH Health Report. google scholar
  • CAH Health (2022). Staying happy, healthy, and vaccinated. CAH Health Report. staying_happy_healthy_vax google scholar
  • Cancer Early Diagnosis, Screening and education centers. (accessed 21.07.2023) (in Turkish) google scholar
  • Camerer, C., Issacharoff, S., Loewenstein, G., O’Donoghue, T., & Rabin, M. (2003). Regulation for conserva-tives: Behavioral economics and the case for “asymmetric paternalism.” University of Pennsylvania Law Review, 151(3), 1211-1254. google scholar
  • Chater, N., & Loewenstein, G. (2022). The i-frame and the s-frame: How focusing on individual-level solutions has led behavioral public policy astray. The Behavioral and brain sciences, 46, e147. S0140525X22002023 google scholar
  • Cialdini, R.B. (2008). Influence: Science and practice, 5th ed. Boston: Pearson. google scholar
  • Dovidio, J.F. (1999). Stereotyping. In: Wilson, R.A., Keil, F.C. (Eds.), The MIT encyclopedia of the cognitive sciences. MIT Press, Cambridge, MA. google scholar
  • Frank, R. (2016 [2007]) Davranışsal iktisat ve sağlık ekonomisi, In Kamilcelebi, H. (Ed) (in Turkish), (Dublen Göksu, Y., Trans.) (in Turkish) Davranışsal iktisat ve davranışsal iktisadın uygulamaları. Nobel Yayınevi: Ankara. In Diamond, P., & Vartiainen, H. (Eds), Behavioral economics and its applications, Princeton University Press. google scholar
  • Gigerenzer G. (2008). Why heuristics work. Perspectives on psychological science, 3(1), 20-29. https://doi. org/10.1111/j.1745-6916.2008.00058.x google scholar
  • Halpern, S. D., Ubel, P. A., & Asch, D. A. (2007). Harnessing the power of default options to improve health care. The New England journal of medicine, 357(13), 1340-1344. google scholar
  • Harwood, J., & Sparks, L. (2003). Social identity and health: an intergroup communication approach to cancer. Health communication, 15(2), 145-159. google scholar
  • Hiroto, D. S., & Seligman, M. E. (1975). Generality of learned helplessness in man. Journal of Personality and Social Psychology, 31(2), 311-327. google scholar
  • Johnson, E. J., & Goldstein, D. (2003). Do defaults save lives?. Science, 302(5649), 1338-1339. https://doi. org/10.1126/science.1091721 google scholar
  • Johnson, E. J., Shu, S. B., Dellaert, B. G. C., Fox, C., Goldstein, D. G., Haubl, G., Larrick, R. P., Payne, J. W., Peters, E., Schkade, D., Wansink, B., & Weber, E. U. (2012). Beyond nudges: Tools of a choice archite-cture. Marketing Letters: A Journal of Research in Marketing, 23(2), 487-504. s11002-012-9186-1 google scholar
  • Kahneman, D., & Frederick, S. (2002). Representativeness revisited: Attribute substitution in intuitive judgment. In T. Gilovich, D. Griffin, & D. Kahneman (Eds.), Heuristics of intuitive judgment: Extensions and appli-cations (pp. 49-81). New York: Cambridge University Press. google scholar
  • Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decision under risk. Econometrica, 47(2), 263-291. google scholar
  • Kahneman, D., Jack L. K., & Thaler, R. H. (1991). Anomalies: The endowment effect, loss aversion, and status quo bias. Journal of Economic Perspectives, 5, 193-206. google scholar
  • Kamilcelebi, H. (2021). Will the covid-19 outbreak eliminate owners and buyers’ egocentric empathy gap? An experiment on endowment effect. In Nuriye Gures (Ed.), Current Economics and Management Sciences Research, (pp. 59-71). Lyon: Livre de Lyon. google scholar
  • Kremer, M., Rao, G., & Schilbach, F. (2019). Behavioral development economics, In B. D. Bernheim, S. Del-laVigna, D. Laibson (Eds.), Handbook of behavioral economics: Applications and foundations 1, 2, (pp. 345-458). google scholar
  • Loewenstein G. (2005). Projection bias in medical decision making. Medical decision making : an in-ternational journal of the Society for Medical Decision Making, 25(1), 96-105. https://doi.or-g/10.1177/0272989X04273799 google scholar
  • Loewenstein, G., Brennan, T., & Volpp, K. G. (2007). Asymmetric paternalism to improve health behaviors. JAMA, 298(20), 2415-2417. google scholar
  • McKenzie, C. R., Liersch, M. J., & Finkelstein, S. R. (2006). Recommendations implicit in policy defaults. Ps-ychological science, 17(5), 414-420. google scholar
  • Mehta, S. J., Khan, T., Guerra, C., Reitz, C., McAuliffe, T., Volpp, K. G., Asch, D. A., & Doubeni, C. A. (2018). A randomized controlled trial of opt-in versus opt-out colorectal cancer screening outreach. The American journal of gastroenterology, 113(12), 1848-1854. google scholar
  • Mehta, S. J., & Asch, D. A. (2014). How to help gastroenterology patients help themselves: leveraging insights from behavioral economics. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 12(5), 711-714. google scholar
  • Morris, S. S., Flores, R., Olinto, P., & Medina, J. M. (2004). Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial. Lancet, 364(9450), 2030-2037. google scholar
  • O’Donoghue, T., & Rabin, M. (1999). Doing it now or later. American Economic Review, 89(1), 103-124. google scholar
  • O’Donoghue, T., & Rabin, M. (2015). Present bias: Lessons learned and to be learned. The American Economic Review, 105(5), 273-279. google scholar
  • Pallier, G., Wilkinson, R., Danthiir, V., Kleitman, S., Knezevic, G., Stankov, L., & Roberts, R. D. (2002). The role of individual differences in the accuracy of confidence judgments. Journal of General Psychology, 129(3), 257-299. google scholar
  • Purnell, J. Q., Thompson, T., Kreuter, M. W., & McBride, T. D. (2015). Behavioral economics: “nudging” under-served populations to be screened for cancer. Preventing chronic disease, 12, E06. pcd12.140346 google scholar
  • Redelmeier, D. A., & Kahneman, D. (1996). Patients’ memories of painful medical treatments: real-time and ret-rospective evaluations of two minimally invasive procedures. Pain, 66(1), 3-8. google scholar
  • Ritov, I., & Baron, J. (1990). Reluctance to vaccinate: Omission bias and ambiguity. Journal of Behavioral Decision Making, 3(4), 263-277. google scholar
  • Samuelson, W., Zeckhauser, R. (1988). Status quo bias in decision making. Journal of Risk and Uncertainty, 1, 7-59 google scholar
  • Saribay, S. A., Biten, A. F., Meral, E. O., Aldan, P., Trebicky, V., & Kleisner, K. (2018). The Bogazici face da-tabase: Standardized photographs of Turkish faces with supporting materials. PLoS ONE, 13(2), e0192018. 10.1371/journal.pone.0192018. google scholar
  • Sey, N. & Demiröz, D. M. (2023). The relationship between health systems and health expenditures in OECD countries: An econometric approach. Ekonomik ve Sosyal Araştırmalar Dergisi, 19(1), 41-58. google scholar
  • Shepperd J.A., Carroll P., Grace J., & Terry, M. (2002). Exploring the causes of comparative optimism. Psycho-logica Belgica. 42, 65-98. google scholar
  • Slovic, P., Finucane, M. L., Peters, E., & MacGregor, D. G. (2002). The affect heuristic. In T. Gilovich, D. Griffin, & D. Kahneman (Eds.), Heuristics and biases: The psychology of intuitive judgment (pp. 397-420). New York: Cambridge University Press. google scholar
  • Solbj0r, M., & Willis, K. (2021). Informed choice and nudging in mammography screening: a discourse analy-sis of australian and scandinavian webpages. Science, Technology and Society, 26(1), 64-80. https://doi. org/10.1177/0971721820964890 google scholar
  • Sunstein, C. R. (2016). The ethics of influence: Government in the age of behavioral science. New York: Camb-ridge University Press. google scholar
  • Sunstein, C. R. (2018). “Better off as judged by themselves”: A comment on evaluating nudges. International Review of Economics, 65, 1-8. google scholar
  • Tajfel, H., & Turner, J. C. (1986). The social identity theory of intergroup behavior. In S. Worschel & W. G. Austin (Eds.), The social psychology of intergroup relations (2nd ed., pp. 7-24). Chicago: Nelson Hall. google scholar
  • The Ministry of Health of the Republic of Türkiye General Directorate of Public Health Official Website. Cancer screening. (accessed 26.07.2023) google scholar
  • The Ministry of Health of the Republic of Türkiye Website, Annual report for 2022. https://dosyamerkez.saglik. (accessed 21.08.2023) google scholar
  • The Ministry of Health of the Republic of Türkiye Website, Health statistics yearbook 2021. https://dosyasb.,siy2021-ingilizcepdf.pdf?0 (accessed 21.08.2023) google scholar
  • The Ministry of Health of the Republic of Türkiye Healthy Life Center Website, Image, tr/ (accessed 21.07.2023) (in Turkish) google scholar
  • The Ministry of Health of the Republic of Türkiye Website, 2019-2023 Strategic plan. https://dosyamerkez. pdf?_tag1=51DF1549087EE46B936F1419E77B92147160F491 (accessed 21.07.2023) (in Turkish). google scholar
  • The Ministry of Health of the Republic of Türkiye General Directorate of Public Health Official Website. Image. (accessed 26.07.2023) google scholar
  • The United Nations Website, Sustainable development goals. ( (26.07.2023) google scholar
  • Thaler, R. H., & Benartzi, S. (2004). Save more tomorrowTM: Using behavioral economics to increase employee saving. Journal of'PoiiticalEconomy, 112(S1), S164-S187. google scholar
  • Thaler, R. H., & Sunstein, C. R. (2008). Nudge: Improving decisions about health, wealth, and happiness. Yale University Press. google scholar
  • Thaler, R. H., & Sunstein, C. R. (2009). Nudge: Improving decisions about health, wealth and happiness, New York: Penguin Books. google scholar
  • Tversky, A., & Kahneman, D. (1974). Judgment under uncertainty: Heuristics and biases. Science (New Series), 185, 1124-1131. google scholar
  • Tversky, A., Kahneman, D. (1989). Rational choice and the framing of decisions. In: Karpak, B., Zionts, S. (eds) Multiple Criteria Decision Making and Risk Analysis Using Microcomputers. NATO ASI Series, 56. Springer, Berlin, Heidelberg. google scholar
  • Webb, T.L., Chang, B.P.I., & Benn, Y. (2013), ‘The ostrich problem’: Motivated avoidance or rejection of information about goal progress. Social and Personality Psychology Compass, 7, 794-807. https://doi. org/10.1111/spc3.12071 google scholar


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