Dominated Choices and Medicare Advantage Enrollment

Afendulis, Christopher C.; Sinaiko, Anna D.; Frank, Richard G.

doi:10.3386/w20181

Cited by 17 publications

(21 citation statements)

References 13 publications

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“…Afendulis et al, who compared the enrollment decisions of Medicare beneficiaries in the United States, found that the longer an individual had been enrolled in an inferior program, the less likely the individual was to switch to a newly offered superior program. 12 In our study, individuals had not been allowed to switch their health insurance before 1996. Hence, age can be seen as a proxy for the length of enrollment and the age effect might be at least partially explained by that.…”

Section: Discussionmentioning

confidence: 99%

“…decisions regarding health insurance plans. 12,13 Large-scale studies often exploit natural experiments, e.g. when at some point in life individuals are offered to switch to a new superior health care plan.…”

Section: Introductionmentioning

confidence: 99%

“…12 For example, Sinaiko et al, and Afendulis et al, showed that the probability of switching to a superior insurance program among Medicare beneficiaries decreased with the time spent in an inferior program. 12,14 The advantage of such natural experiments is that they reflect real world decisions. However, few studies linked SQB with health behavior of individuals that supposedly is affected by SQB.…”

Section: Introductionmentioning

confidence: 99%

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Status quo bias and health behavior: findings from a cross-sectional study

Karl

Holle

Schwettmann

et al. 2019

European Journal of Public Health

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Background Status quo bias (SQB) has often been referred to as an important tool for improving public health. However, very few studies were able to link SQB with health behavior. Methods Analysis were based on data from the population-based KORA S4 study (1999–2001, n = 2309). We operationalized SQB through two questions. The first asked whether participants switched their health insurance for financial benefits since this was enabled in 1996. Those who did were assigned a ‘very low SQB’ (n = 213). Participants who did not switch were asked a second hypothetical question regarding switching costs. We assigned ‘low SQB’ to those who indicated low switching costs (n = 1035), ‘high SQB’ to those who indicated high switching costs (n = 588), and ‘very high SQB’ to those who indicated infinite switching costs (n = 473). We tested the association between SQB and physical activity, diet, smoking, alcohol consumption, the sum of health behaviors, and body mass index (BMI) using logistic, Poisson and ordinary least square regression models, respectively. Models were adjusted for age, sex, education, income, satisfaction with current health insurance and morbidity. Results SQB was associated with a higher rate of physical inactivity [OR = 1.22, 95% CI (1.11; 1.35)], a higher sum of unhealthy lifestyle factors [IRR = 1.05, 95% CI (1.01; 1.10)] and a higher BMI [β = 0.30, 95% CI (0.08; 0.51)]. Conclusion A high SQB was associated with unfavorable health behavior and higher BMI. Targeting SQB might be a promising strategy for promoting healthy behavior.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Status quo bias and health behavior: findings from a cross-sectional study

Karl

Holle

Schwettmann

et al. 2019

European Journal of Public Health

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“…This study increases knowledge of how patients' clinician choices are influenced by the level of aggregation and presentation of healthcare quality data. Some questions about roll-up scores remain unaddressed, including how clinicians or health plans respond to roll-up measures or use them to guide quality improvement initiatives 32,33 and determining best methods of roll-up score calculation.…”

Section: Discussionmentioning

confidence: 99%

Improving Patients’ Choice of Clinician by Including Roll-up Measures in Public Healthcare Quality Reports: an Online Experiment

Cerully

Parker

Rybowski³

et al. 2018

J GEN INTERN MED

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BACKGROUND: Public reports on healthcare quality typically include complex data. To lower the cognitive burden of interpreting these data, some report designers create summary, or roll-up, measures combining multiple indicators of quality into one score. Little is known about how the availability of roll-ups affects clinician choice. OBJECTIVE: To determine how presenting quality scores at different levels of aggregation affects patients' clinician choices. DESIGN: We conducted a simulated clinician-choice experiment, randomizing participants to three versions of a public reporting website and comparing their clinician choices. One version aggregated all clinician-level quality measures into roll-ups, the second provided disaggregated (drill-down) scores only, and the third offered both roll-ups and drill-downs. PARTICIPANTS: Five hundred fifty panelists drawn from a probability-based Internet panel. MAIN MEASURES:We assessed the amount of effort participants exerted by tracking the length of time spent on the website and the number of concrete actions taken on the website (e.g., clicking items). We evaluated decision quality by measuring whether participants selected a clinician who performed more poorly than others and incongruence between participants' stated preferences for dimensions of quality and their chosen clinician's performance on those dimensions. KEY RESULTS: Participants seeing drill-downs alone (mean = 14.9) or with roll-ups (mean = 19.2) took more actions than those who saw roll-ups alone (mean = 10.5) (ps < 0.05). However, participants seeing only drill-downs made poorer choices than those who saw roll-ups alone or with drill-downs. More participants seeing drill-downs chose a clinician who was outperformed (36.3% versus 23.4% [roll-up] and 25.6% [drill-down + roll-up], ps < 0.05) and made choices incongruent with stated preferences (51.2% versus 45.6% [roll-up] and 47.5% [drilldown + roll-up], ps < 0.05). The distinction between rollup and drill-down was somewhat stronger for sicker participants. CONCLUSIONS:Our results suggest that roll-ups in healthcare quality reports, alone or as a complement to drill-downs, can help patients make better decisions for themselves.KEY WORDS: healthcare quality; patient experience; patient satisfaction; composite measure; summary score. J Gen Intern Med 34(2):243-9

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“…A significant example is status quo bias in the Medicare market, which causes some individuals who enrol in MA to remain in the programme over long periods of time. Indeed, only a tiny fraction of enrolees in TM switch into MA (Sinaiko et al , 2013; Afendulis et al , 2014). McWilliams et al (2011) find evidence consistent with ‘choice overload’, showing that rates of enrolment in MA increased as plan choices increased up to 15, then plateaued with 16–30 plan choices and then declined when beneficiaries had more than 30 choices available.…”

Section: Study Context Data and Methodsmentioning

confidence: 99%

Enrolee outcomes after health insurance plan terminations: a diagnosis of default effects

Sinaiko

Zeckhauser

2018

Behav. Public Policy

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Behavioural economic research has established that defaults, one form of nudge, powerfully influence choices. In most policy contexts, all individuals receive the same nudge. We present a model that analyses the optimal universal nudge for a situation in which individuals differ in their preferences and hence should make different choices and may incur a cost for resisting a nudge. Our empirical focus is onterminated choosers(TCs), individuals whose prior choices become no longer available. Specifically, we examine the power of defaults on individuals who had enrolled in Medicare Advantage plans with drug coverage and whose plans were then discontinued. Currently, if these TCs fail to actively choose another Medicare Advantage plan, they are defaulted into traditional fee-for-service Medicare (TM) without drug coverage. Overall, the rate of transition of TCs into TM is low, implying that original preferences and status quo bias overpower the default. Increasing numbers of Americans are choosing plans in health insurance exchange settings such as Medicare, the Affordable Care Act and private exchanges. Plan exits and large numbers of TCs are inevitable, along with other forms of turmoil. Any guidance and defaults provided for TCs should factor in their past revealed preferences.

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Dominated Choices and Medicare Advantage Enrollment

Cited by 17 publications

References 13 publications

Status quo bias and health behavior: findings from a cross-sectional study

Status quo bias and health behavior: findings from a cross-sectional study

Improving Patients’ Choice of Clinician by Including Roll-up Measures in Public Healthcare Quality Reports: an Online Experiment

Enrolee outcomes after health insurance plan terminations: a diagnosis of default effects

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