Encouraging Mammograms Using Behavioral Economics: A Randomized Controlled Trial in Chile

  • Fabián Duarte
    Correspondence: Fabián Duarte, PhD, Economics Department, University of Chile, Diagonal Paraguay 257, Santiago 8330015, Chile.
    Economics Department, University of Chile and Millennium Nucleus in Social Development, Santiago, Chile
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      • Women face psychological and material barriers in taking advantage of free mammograms.
      • The use of free mammography increased 167% on average owing to interventions designed to address these barriers.
      • This research provides a framework for understanding the low rates of free mammography use and a potential channel for improvement.



      This article illustrates the effect of a direct mail campaign that used insights from behavioral economics and psychology to increase the number of free mammograms in Chilean women aged 50 years or older.


      We hypothesized 4 barriers in obtaining a mammogram based on previous literature and focus group analysis. A behavioral economic approach providing incentives was used to help overcome these barriers. We accessed a unique data set, which comprised 12 000 women 50 years old or older, with private health insurance who have not had a mammogram for 24 or more months. We conducted a randomized controlled trial with 8 treatments, each involving a specific combination of messages.


      The intervention overall led to a 167% increase in the use of free mammograms, a 1.13% to 3.03% average increase from the control to treatment groups, respectively. Regarding barriers, we found that all messages were effective, with a slightly larger and persistent effect for the less complex ones in terms of information. This finding illustrates the benefits of keeping the message simple.


      Finally, these results suggest a successful public policy for increasing use of free mammography programs. Moreover, they are potentially transferable because the study considered decision-making heuristics that are not specific to one culture or social context.


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