• Ethics

Sunstein and Thaler's book Nudge: Improving Decisions About Health, Wealth and Happiness,1 described a fictional species, Econs. Econs are perfectly rational humans. They optimise their pensions, they read the small print, and they never procrastinate. They are the citizens governments dream of.

But real-life citizens are more Muggles than Econs. We get loans from our own bank instead of shopping around, and our pension-plans, ignored, gather dust. Financial incentives for beneficial behaviours have been suggested as one of a range of “nudge” strategies that push Muggles to behave more like Econs-trying to find, but not cross, the line that separates laziness from choice. This issue looks at a wide range of ethical issues surrounding the use of such incentives in healthcare.

Financial incentives are potentially powerful ways of improving a range of health outcomes. But they risk forming part of an over-simplified nudge narrative. For this reason, I think this special issue is timely and important.

The nudge narrative has its own fictional characters. Take Gandalf. Gandalf is the perfectly rational policy-maker. He has a flawless understanding of both the evidence—which is itself clear and uncontested of course—and of human psychology. He creates an incentive structure which will meet the goal without unintended effects, and yet he never lets outside influences, …