Medicine Meets Behavioural Economics: Why Better Healthcare Isn't Just About Better Medicine

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Before this interview, I assumed that the biggest challenge in pediatric endocrinology was making the right diagnosis. Speaking with Dr. Abhishek Kulkarni: - Professor Pediatric & Adolescent Endocrinology - Senior Consultant at Sir H.N. Reliance Foundation Hospital - Senior Consultant at SRCC Children's Hospital , Mumbai,

I completely changed that perspective. While scientific breakthroughs continue to transform how endocrine disorders are diagnosed and treated, he explained that the greatest barriers to better outcomes are often behavioural, economic and systemic rather than clinical.

As someone interested in business and economics, I found myself viewing healthcare through a very different lens. Every consultation involves decisions made under uncertainty - not only by doctors, but also by parents, schools, policymakers and healthcare providers. Success depends not simply on having the right treatment available, but on whether families can access it, afford it, understand it, and continue with it over many years.

One of the strongest themes throughout our conversation was that medicine is ultimately a problem of human behaviour. A diagnosis only creates the opportunity for better health; the outcome depends on countless everyday decisions that follow. This is where behavioural economics becomes surprisingly relevant.

Dr. Kulkarni described several remarkably simple interventions that consistently improve treatment adherence. Rather than relying on willpower alone, medications are linked to existing daily routines - a concept behavioural economists refer to as habit anchoring. Growth hormone injections become part of a child's bedtime routine after brushing their teeth, while thyroid medication is taken immediately after waking. Small environmental changes, such as placing medicines beside a toothbrush or using digital reminders, reduce what economists call the "friction cost" of making good decisions. Instead of expecting people to remember, the environment is designed to make the desired behaviour the easiest option.

Another powerful principle is immediate feedback. Children are naturally more motivated when they can see visible progress through growth charts, glucose trends or improvements in weight. Rather than focusing only on the long-term health benefits - which may feel abstract - these visual indicators provide immediate reinforcement, encouraging consistent behaviour. For younger children, turning treatment into a game through rewards and progress tracking further increases engagement. These strategies closely mirror the principles of Nudge Theory, where small changes in choice architecture influence behaviour without restricting choice.

As children enter adolescence, however, the behavioural challenge changes. Treatment adherence becomes less about reminders and more about identity, independence and social influence. Teenagers often understand exactly what they should do, yet choose differently because of peer pressure, treatment fatigue or the desire to feel "normal." Managing chronic illness therefore becomes an exercise in understanding psychology as much as physiology.

The discussion also highlighted how healthcare is fundamentally a systems challenge. Parents remain the primary decision-makers during childhood, but schools increasingly influence outcomes as children grow older, particularly for conditions such as Type 1 Diabetes that require monitoring throughout the school day. The best results are achieved not through isolated medical expertise, but through coordination between families, educators and healthcare professionals—an example of how incentives and shared responsibility can shape outcomes across an entire system.

Our conversation naturally expanded beyond individual patients to healthcare delivery across India. Despite significant advances in precision genomics, artificial intelligence, continuous glucose monitoring and long-acting hormone therapies, access remains uneven. The shortage of pediatric endocrinologists, concentration of specialist services in metropolitan centres, limited insurance coverage and high treatment costs mean that many children receive care far later than they should. From an economic perspective, this represents a classic allocation problem: remarkable medical innovations exist, yet the resources required to deliver them are not distributed equitably.

Socioeconomic factors add another layer of complexity. Families with limited financial resources may postpone investigations, discontinue long-term therapies or struggle to attend regular follow-up appointments. Cultural beliefs and limited health literacy can delay diagnosis even further. In behavioural economics, these are examples of how financial constraints, information asymmetry and cognitive biases influence decision-making—often with lifelong consequences.

Perhaps the most striking insight from Dr. Kulkarni was that many solutions are already known. Universal newborn screening, routine growth monitoring, wider use of telemedicine, improved training for primary care physicians and greater public awareness all have the potential to identify endocrine disorders much earlier. The challenge is no longer one of scientific discovery, but of implementation. In many ways, the future of pediatric endocrinology will depend as much on better systems, smarter policies and behavioural design as it will on the next medical breakthrough.

This interview reinforced something that has emerged repeatedly throughout my conversations with professionals across different sectors: regardless of the industry, the greatest challenges are rarely technical alone. Whether leading a business, managing an organisation or improving healthcare, success depends on understanding people, designing effective systems and creating environments that help individuals make better decisions. That intersection of economics, behaviour and leadership is precisely what continues to make this interview series so fascinating.