"Are they talking to us?" - Nudges Versus Nuisances to Save Lives

Excerpts from "The Why Axis: Hidden Motives and the Undiscovered Economics of Everyday Life" by Uri Gneezy and John List

Chapter 8

How Can We Save Ourselves from Ourselves?

Using Field Experiments to Inform Life and Death Situations

In 2007, we teamed up with Dean Karlan of Yale University to see whether it would be possible to increase donor rates even if we were explicit about it.10 In our case, we decided to see what we could do to raise donations of corneas, which are in short supply. We worked with a nonprofit called Donate Life, whose mission is to increase organ donation, and ran an experiment that pitted nudges against a different approach—“nuisances.”

As it happened, the state of Illinois had recently introduced a new system of donor registration. People who had been previously registered as organ donors needed to reregister as a result of a change in the law. So we ran a test in which our research assistants talked to more than 400 households in various neighborhoods around Chicago. The students told people that because of a new driver registry, they unfortunately might not be registered anymore. Then the students popped the big question: “Would you like to receive information on signing up as an organ donor?” If they chose to opt in to receiving information, they filled in a form with their name, address, gender, date of birth, and so on. Of those we asked, 24 percent signed up, giving us our baseline group.

But what if we changed the default option and households had to opt out in order to not receive any information? In another treatment, people who didn’t want the information had to fill out the same form with their names, addresses, and so on if they wanted to opt out. This time, 31 percent of the people we asked signed up. It looked like changing the default was enough of an incentive to get more people to participate.

In yet another test, we made the signup form much shorter. In fact, all people had to do was write down their names to receive information from Donate Life. This time, 32 percent of people signed up to receive the information. This result showed that we could still get more donors this way than we could by directly asking them to opt in.

The results showed that reducing nuisances—and saving people time and hassle—worked slightly better than nudges, which means we do not necessarily need to use default to achieve the same level of success when signing people up. We can be explicit and still achieve better sign-up rates.

These results have potentially important implications beyond donating organs. For instance, Americans don’t save enough for retirement. To increase peoples’ savings rates, many argue that the default trick can work well. Our results suggest that simply lowering nuisances and explaining savings rules, clearly and simply, might do a similar trick. Likewise, reducing nuisances in helping make the right choice of health plan can go a long way toward getting them enrolled. (Of course, we’d need to do more field experiments to see whether such incentives could work.)