Numeracy and Medicare Part D: The importance of choice and literacy for numbers in optimizing decision making for Medicare's prescription drug program.

Wood, Stacey; Hanoch, Yaniv; Barnes, Andrew J.; Liu, Pi-Ju; Cummings, Janet R.; Bhattacharya, Chandrima; Rice, Thomas

doi:10.1037/a0022028

Cited by 89 publications

(87 citation statements)

References 49 publications

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“…Furthermore, in the decision-making and cognitive aging literature, researchers have shown that strategies such as presenting less information (i.e., reducing cognitive load) when making complex decisions can effectively increase older adults' decision-making capabilities (e.g., medical decision, Wood et al, 2011). Finally, although there has been limited success in reducing HB by educating individuals on the bias (Fischhoff, 1982), developing awareness of the bias is essential so that protective mechanisms can be implemented.…”

Section: The Implications Of Hindsight Bias In Older Adultsmentioning

confidence: 99%

Explaining individual differences in cognitive processes underlying hindsight bias

et al. 2014

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Outcome knowledge influences recall of earlier predictions of an event. Compared to younger adults, older adults are more susceptible to the two underlying bias processes that contribute to this hindsight bias (HB) phenomenon, recollection bias and reconstruction bias. However, the role of cognitive abilities in these processes remains unclear. In Experiment 1, we extended the multinomial processing tree model for HB by incorporating individual variation in cognitive abilities into parameter estimation in a sample of 60 older (M = 72.50, range = 65 to 87) and 62 younger (M = 20.10, range = 18 to 25) adults. In older adults, our findings revealed that (1) higher episodic memory was associated with higher recollection ability in the absence of outcome knowledge, (2) higher episodic memory, inhibitory control, and working memory capacity were associated with higher recollection ability in the presence of outcome knowledge, and (3) higher inhibitory control was associated with less reconstruction bias. Although the pattern of effects was similar in younger adults, the cognitive covariates did not significantly predict the underlying processes in this age group.In Experiment 2, we collected memory judgment HB data on an additional 80 older adults (M = 71.40, range = 65 to 87) to assess whether a) experimentally increasing inhibition demands via outcome rehearsal during the HB task impacts the underlying HB processes, and b) the effects of this cognitive load manipulation on the underlying HB processes vary with an individuals' inherent cognitive abilities. Our findings revealed that cognitive load increased recollection bias independently of individuals' cognitive abilities. I would like to give a special thank you to Brant for his inspiration and statistical assistance, and his endless love and confidence in me.vi

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Section: The Implications Of Hindsight Bias In Older Adultsmentioning

confidence: 99%

Explaining individual differences in cognitive processes underlying hindsight bias

et al. 2014

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“…Recent systematic reviews have demonstrated that low health literacy test scores are associated with numerous adverse health outcomes and poor use of health care services (Berkman, Sheridan, Donahue, Halpern, Viera, et al, 2011;. Likewise, numeracy skills have been implicated in the ability to benefit from health care (Galesic & Garcia-Retamero, 2011;Wood et al, 2011). In order to lift literacy-related barriers to health, enhancing patients' health literacy and numeracy (Baur & Ostrove, 2011;Galesic & Garcia-Retamero, 2011;Rudd, Soricone, Santos, Zobel, & Smith, 2005) and adjusting services to low literacy levels (Rudd, 2010) have been suggested.…”

Section: Introductionmentioning

confidence: 99%

Towards understanding the links between health literacy and physical health.

Mõttus¹,

Johnson²,

Murray³

et al. 2014

Health Psychology

104

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Objective: Low health literacy predicts poor health, but the underpinnings of the associations are yet to be understood. This study tested the associations between health literacy and three objective health outcomes in older people and investigated the extent to which general (not health-related) cognition and earlier life-course factors such as childhood cognitive ability, educational level and occupational class accounted for these associations. Methods: Participants were 730 community-dwelling older people (350 women; mean age 72.50 years, SD = 0.71). Physical fitness (defined by walk time, lung function, and grip strength), body mass index, and count of natural teeth were used as health outcomes. Rapid Estimate of Adult Literacy in Medicine (REALM), Shortened Test of Functional HealthLiteracy in Adults (S-TOFHLA), and Newest Vital Sign (NVS) were used to measure health literacy.Age-11 and concurrent general cognitive ability, educational level, and occupational social class were used as co-variates. Results: Lower REALM, S-TOFHLA and NVS scores were associated with worse scores on all health outcomes (β = .09 to .17). However, cognitive ability in old age and childhood, educational and occupational levels accounted for the majority of these associations: after adjusting for these co-variates, only physical fitness was significantly associated with REALM and S-TOFHLA (β = .06 and .11). Conclusions: Low health literacy was associated with poorer health largely because it reflected general cognitive ability, educational and/or occupational levels. These variables plays some role in health beyond their association with the reading and numeracy skills captured by common health literacy measures.

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“…5,6 Absent actionable plan information, choices may be informed by brand recognition, word of mouth, or other sources. [7][8][9] When information is available, interpreting numerous complex options is challenging; [10][11][12][13][14][15] beneficiaries may not be equipped to weigh the worth of attributes, including quality.…”

Section: Introductionmentioning

confidence: 99%

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

et al. 2015

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BACKGROUND:To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions. OBJECTIVE: We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.e., costs, quality, and benefits) and brand market share and beneficiaries' enrollment decisions. DESIGN, SETTING, PARTICIPANTS: We performed a nationwide, beneficiary-level cross-sectional analysis of 847,069 beneficiaries enrolling in Medicare Advantage for the first time in 2011. MAIN MEASURES: Matching beneficiaries with their plan choice sets, we used conditional logistic regression to estimate associations between plan attributes and enrollment to assess the proportion of enrollment variation explained by plan attributes and willingness to pay for quality. KEY RESULTS: Relative to the total variation explained by the model, the variation in plan choice explained by premiums (25.7 %) and out-of-pocket costs (11.6 %) together explained nearly three times as much as quality ratings (13.6 %), but brand market share explained the most variation (35.3 %). Further, while beneficiaries were willing to pay more in total annual combined premiums and out-of-pocket costs for higher-rated plans (from $4,154.93 for 2.5-star plans to $5,698.66 for 5-star plans), increases in willingness to pay diminished at higher ratings, from $549.27 (95 %CI: $541.10, $557.44) for a rating increase from 2.5 to 3 stars to $68.22 (95 %CI: $61.44, $75.01) for an increase from 4.5 to 5 stars. Willingness to pay varied among subgroups: beneficiaries aged 64-65 years were more willing to pay for higherrated plans, while black and rural beneficiaries were less willing to pay for higher-rated plans. CONCLUSIONS: While beneficiaries prefer higher-quality and lower-cost Medicare Advantage plans, marginal utility for quality diminishes at higher star ratings, and their decisions are strongly associated with plans' brand market share.

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Numeracy and Medicare Part D: The importance of choice and literacy for numbers in optimizing decision making for Medicare's prescription drug program.

Cited by 89 publications

References 49 publications

Explaining individual differences in cognitive processes underlying hindsight bias

Explaining individual differences in cognitive processes underlying hindsight bias

Towards understanding the links between health literacy and physical health.

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

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