Perceived norms can also influence choice, authors wrote in Health Affairs. Individuals also frequently select the default setting. “Decisionmaking is predictably affected by the tendency people have to prefer that things remain the same,” they said.

Individuals can also be blind to all but the most novel and relevant information that holds our limited attention, what the authors describe as salience.

In Florida, researchers suggested that small financial awards to enroll in smoking cessation were not salient and so Medicaid enrollees did not participate. “In the end, the program's lack of effectiveness in improving behavioral outcomes may have been because it paid enrollees far less ($15) than the rewards ($500-$750) that have typically been effective in changing behavior such as smoking,” according to a study, also published in Health Affairs.

Environmental cues, known as priming, can influence choices and so can emotional reactions, the London researchers said. Commitments, or a pledge that can be tied to an incentive, may also help sway behavior. And the desire to “maintain a positive self-image” could be motivating when people are offered rankings or other public performance measures.

At Horizon Blue Cross and Blue Shield of New Jersey, officials are broadly examining behavioral economics, said Jay Driggers, director of customer insight and experience. The insurer is interested in research that suggests that the way information and incentives are conveyed matters, he said. One pilot underway will test whether rewards (vacation time) offered through a lottery will increase preventive screening.

Driggers said the New Jersey Blues is also interested in how individuals' desire to avoid loss can be a motivating tool. The insurer is testing a weight-loss incentive among its own employees that uses the desire to avoid loss among the incentives, he said.

“We know human nature is what it is,” Driggers said. “We know we should exercise regularly. We know we should not smoke, and drink in moderation only” but rational thought does not always lead to action.

The insurer is looking for “extrinsic motivators” that will sway people to healthy choices, he said.