Loss Aversion for Patient Adherence: Lessons From Wellth
By DeltaMV Insights TeamUpdated 5 min read
Roughly half of all patients don’t take their medications as prescribed, and the cost to health systems is enormous. Loss aversion offers a powerful lever for patient adherence: a sum of money you already have and stand to lose is much harder to ignore than a reward you might earn. Wellth, a digital health company, builds its mobile app around this idea.
Key takeaways
- Losing $20 feels roughly twice as bad as winning $20 feels good.
- Wellth lets patients keep a monthly reward for taking their medication, and deducts $2 for every missed day.
- In the Philippines, a loss-based commitment contract helped smokers quit.
What Is Wellth?
Wellth is a digital health company – founded in New York in 2014 and now based in Los Angeles – that uses behavioural economics to help healthcare and insurance organisations improve health outcomes and avoid preventable costs.
The problem is real and expensive. In the US, around one in five new prescriptions is never filled1, and roughly half of all patients don’t take their medications as prescribed2. Poor adherence is estimated to cost up to $300 billion annually in avoidable spending3, and an oft-cited industry estimate links around 125,000 deaths a year to non-adherence4.
How Does Wellth Use Loss Aversion to Improve Patient Adherence?
Wellth leans on loss aversion – the idea that people are more sensitive to losses than to equivalent gains. A patient leaves hospital with a prescription, downloads the app and can earn up to $75–125 a month simply by taking their medication as directed:
- A daily check-in: the app sends a reminder and asks for a quick selfie confirming the dose.
- A small, immediate loss: miss a day, and the patient loses $2 from that month’s balance.
- Extra prompts: further reminders arrive before the deadline, so the loss can always be avoided.
Because it’s framed as a loss rather than a forgone gain, it’s far more motivating than an equivalent reward. Read more on the basics of loss aversion.
Does Loss Aversion Improve Patient Adherence? Evidence From Wellth
Yes. With AHCCCS, Arizona’s Medicaid programme, Wellth users’ medication adherence rose by around 5 percentage points more than a comparison group, with average savings of $88 per patient over nine months after incentive costs5. The limitation: it’s one US population, so other markets need local testing.
Does Loss Aversion Work in Asia-Pacific? A Case From the Philippines
- Context: smokers in the Philippines, in a randomised trial.
- Intervention: a commitment contract called CARES – participants deposited their own money and forfeited it if they failed a nicotine test six months later.
- Result: they were 3.3 to 5.8 percentage points more likely to have quit6.
- Lesson for practice: putting something the patient values at risk drives extra follow-through – the same mechanism as Wellth.
Planning a patient adherence programme? DeltaMV’s Healthcare Behavioural Strategy team can help you find the leakage points in your patient journey.
How to Build Loss-Averse Nudges Into Your Patient Adherence Strategy
- Find the leakage point – coming forward for treatment, choosing it, or following through.
- Give the reward first, so protecting it becomes the goal.
- Keep the loss small and immediate – felt today, not at the end of the programme.
- Make the right action easy – see how Medisafe goes beyond simple reminders, our ADOPT toolkit and nudges and choice architecture.
What Are the Limitations of Loss-Aversion Programmes?
- Not everyone succeeds: most CARES participants still didn’t quit.
- Design for fairness: losses should be small, transparent and tied to a goal the patient shares.
Frequently Asked Questions
How does the Wellth app work?
Patients can earn up to $75–125 a month by confirming each dose with a selfie; each missed day costs $2.
Does loss aversion work outside the US?
Yes. In the Philippines, smokers offered the CARES commitment contract were 3.3 to 5.8 percentage points more likely to have quit6.
Next Steps: Make Patient Adherence Emotional, Not Just Rational
DeltaMV’s “Make it Emotional” lever moves a programme from a purely rational pitch – take your medication because it’s good for you – to a design with real emotional and financial stakes, as Wellth and CARES both do.
Want to explore whether a loss-framed adherence programme could work for your patients? Get in touch with DeltaMV’s Healthcare Behavioural Strategy team.
References
1. Fischer, M. A., Stedman, M. R., Lii, J., Vogeli, C., Shrank, W. H., Brookhart, M. A., & Weissman, J. S. (2010). Primary medication non-adherence: Analysis of 195,930 electronic prescriptions. Journal of General Internal Medicine, 25(4), 284–290. https://doi.org/10.1007/s11606-010-1253-9
2. Cutler, D. M., & Everett, W. (2010). Thinking outside the pillbox – medication adherence as a priority for health care reform. The New England Journal of Medicine, 362(17), 1553–1555. https://doi.org/10.1056/NEJMp1002305
3. Viswanathan, M., Golin, C. E., Jones, C. D., Ashok, M., Blalock, S. J., Wines, R. C. M., Coker-Schwimmer, E. J. L., Rosen, D. L., Sista, P., & Lohr, K. N. (2012). Interventions to improve adherence to self-administered medications for chronic diseases in the United States: A systematic review. Annals of Internal Medicine, 157(11), 785–795. https://doi.org/10.7326/0003-4819-157-11-201212040-00538
4. American Pharmacists Association Foundation. (2014). A dose of reality: Medication non-adherence causes 125,000 deaths, $290 billion in healthcare costs annually [Press release]. PR Newswire.
5. Stecher, C., Linnemayr, S., Reaven, P., Cloonan, S., & Huckfeldt, P. (2024). Cost savings from an mHealth tool for improving medication adherence. The American Journal of Managed Care, 30(10), e289–e296. https://doi.org/10.37765/ajmc.2024.89621
6. Giné, X., Karlan, D., & Zinman, J. (2010). Put your money where your butt is: A commitment contract for smoking cessation. American Economic Journal: Applied Economics, 2(4), 213–235. https://doi.org/10.1257/app.2.4.213