Consumer Decisionmaking in the Health Care Marketplace

Abstract

For this report, researchers conducted a literature review to better understand how consumers make choices about health insurance enrollment and to assess how website design can influence choice when consumers select plans online. The team also considered how such factors as imperfect information and bounded rationality can influence consumers' health plan choices and whether errors in decisionmaking caused by information failures or bounded rationality can be reduced with better website design. In addition to conducting the literature review, the team reviewed 20 health insurance websites, including 14 websites operated by state-based marketplaces, four private health insurance websites, and two public health insurance websites (the Medicare Plan Finder [Centers for Medicare & Medicaid Services, undated (b)] and the California Public Employees' Retirement System website [California Public Employees' Retirement System, 2016]). In reviewing these websites, the team attempted to understand how the design of the sites might influence choices. After a review of the team's findings, the report concludes with a discussion about how websites could be improved to better support consumers' enrollment decisions. We conducted the literature review and the review of the websites in the spring of 2015. This report will be of interest to policymakers and industry experts involved in designing health insurance websites and researchers who are interested in consumer choice. The work was sponsored by the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. However, the views, opinions, and findings presented here are ours and should not be construed as official government positions unless so designated by other documents. Questions concerning this report can be addressed to Christine Eibner

Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation

“…While five-star quality ratings can summarize health plan cost and quality information, no consensus exists on how to generate or explain them. 16,25 Improving the clinical relevance of these measures (e.g., specifying quality ratings if you are a patient with diabetes) could facilitate better health plan choices.…”

“…Challenges to these recommendation tools include how to account for consumer preferences and willingness to trade-off costs for coverage, and identifying appropriate algorithms since research tends to focus on poor rather than optimal plan choices. 16 While we describe choice environment features, we did not test the accuracy or impact of the tools on consumer choices. Well-designed tools may improve consumer shopping, 8 while inaccurate or poorly explained tools could inadvertently lead to poor choices.…”

“…9 We also surveyed privately run online health insurance exchanges in November-December 2016 for notable features, defined as choice architecture elements not found on the public exchanges, and total cost estimators. From a list of federally approved brokers 15 and RAND-reviewed sites, 16 we identified 23 private online exchanges that, like public online marketplaces, sold multiple private health plans without requiring email or phone communication (Appendix Table 5). These webbrokers completed the registration requirements for the federally facilitated marketplace and listed any on-exchange plans for the same prices as public exchange offerings.…”

Assessing Quality of Healthcare Delivery When Making Choices: National Survey on Health Consumers’ Decision Making Practices

“…These decisions involve how to deal with consuming limited resources and how selection or purchasing decisions are made. [5] Information asymmetry (an imbalance in information) is a particularly important aspect of information gathering, selection and decision-making regarding the engagement and use of healthcare services and facilities. [6] Healthcare systems in most countries are major undertakings and the complexity of those systems creates information asymmetry for consumers.…”

Completing the MISSION: a Blueprint for Helping Veterans Make the Most of New Choices

“…This information could be conveyed through mobile health applications, trained navigators, or peer supporters that have helped patients make difficult health care decisions in other contexts, such as choices about health plans offered through insurance exchanges. 13 It is unknown which of these channels, or others, would be most trusted and used by Veterans. Further, decision support systems will need to accommodate a wide range of users, including Veterans with complex needs or limited health literacy, for whom decisionmaking about VA and community care could be particularly challenging.…”