How individuals choose health insurance : an experimental analysis

An individual choosing a health insurance policy faces a complex decision environment where a large set of alternatives differ on a variety of dimensions. There is uncertainty and the choice is repeated at least once a year. We study decisions and decision strategies in a laboratory experiment where we create a controlled environment that closely mirrors this setting. We use an electronic information board that allows to carefully monitor the individual's decision strategy. The number of alternatives, switching costs, and the speed at which health deteriorates are varied across treatments. We find that most subjects' search is based more on attributes than on policies. Moreover, we find that an increase in the number of alternatives increases decision-making time; makes subjects consider a lower fraction of the available information; makes it more likely that subjects will switch; and decreases the quality of their decisions. The introduction of positive costs of switching makes people switch less often but improves the quality of their decisions. Finally, if health deteriorates only gradually, individuals tend to stick to their current policy too long.

[1]  William Samuelson,et al.  Status quo bias in decision making , 1988 .

[2]  J. Kerssens,et al.  De keuze van ziekenfondsverzekerden voor een zorgverzekeraar , 2002 .

[3]  D. McFadden,et al.  Mind the Gap! Consumer Perceptions and Choices of Medicare Part D Prescription Drug Plans , 2007 .

[4]  A. K. Taylor,et al.  Premiums, benefits, and employee choice of health insurance options. , 1989, Journal of health economics.

[5]  John W. Payne,et al.  Task complexity and contingent processing in decision making: An information search and protocol analysis☆ , 1976 .

[6]  Vicnent P. Crawford.  Look-ups as the Windows of the Strategic Soul: Studying Cognition via Information Search in Game Experiments , 2006 .

[7]  J. Baron,et al.  Omission and commission in judgment and choice , 1991 .

[8]  Arthur Schram,et al.  Artificiality: The tension between internal and external validity in economic experiments , 2005 .

[9]  P Slovic,et al.  Informing consumer decisions in health care: implications from decision-making research. , 1997, The Milbank quarterly.

[10]  Steven P. Cassou,et al.  The Demand for Employment-Based Health Insurance Plans , 1989 .

[11]  Peter P. Groenewegen,et al.  Consumer preferences in social health insurance , 2005, The European Journal of Health Economics.

[12]  Sarah J. Reber,et al.  Paying for Health Insurance: The Tradeoff between Competition and Adverse Selection , 1996 .

[13]  Neil Solomon,et al.  Health Plan Choice: Price Elasticities in a Managed Competition Setting , 1999 .

[14]  S. Iyengar,et al.  The Dark Side of Choice: When Choice Impairs Social Welfare , 2006 .

[15]  Johanna Helena Kerstholt,et al.  The adaptive decision maker: J.W. Payne, J.R. Bettman and E.J. Johnson, Cambridge University Press, Cambridge, 1993 , 1995 .

[16]  A. Rubinstein.  Instinctive and Cognitive Reasoning: A Study of Response Times , 2006 .

[17]  O. Mitchell,et al.  Workers' Preferences among Company-Provided Health Insurance Plans , 1994 .

[18]  V. Smith.  Papers in experimental economics , 1991 .

[19]  T. Buchmueller.  The health plan choices of retirees under managed competition. , 2000, Health services research.

[20]  A. Tversky.  Elimination by aspects: A theory of choice. , 1972 .

[21]  D. Redelmeier,et al.  Medical decision making in situations that offer multiple alternatives. , 1995, JAMA.

[22]  A. Tversky,et al.  Choice under Conflict: The Dynamics of Deferred Decision , 1992 .

[23]  Eric J. Johnson,et al.  Detecting Failures of Backward Induction: Monitoring Information Search in Sequential Bargaining , 2002, J. Econ. Theory.

[24]  Managed competition and consumer price sensitivity in social health insurance. , 2002, Journal of health economics.

[25]  Gur Huberman,et al.  Offering vs. Choice in 401(k) Plans: Equity Exposure and Number of Funds , 2006 .

[26]  M. Elliott,et al.  Effects of CAHPS health plan performance information on plan choices by New Jersey Medicaid beneficiaries. , 2002, Health services research.

[27]  Gur Huberman,et al.  Offering vs. Choice by 401(k) Plan Participants: Equity Exposure and Number of Funds 1 , 2006 .

[28]  Eric J. Johnson,et al.  The adaptive decision maker , 1993 .

[29]  R. Selten,et al.  Money Does Not Induce Risk Neutral Behavior, but Binary Lotteries Do even Worse , 1999 .

[30]  G. Harrison,et al.  Naturally Occurring Preferences and Exogenous Laboratory Experiments: A Case Study of Risk Aversion , 2004 .

[31]  C. Anderson.  The Psychology of Doing Nothing: Forms of Decision Avoidance Result from Reason and Emotion , 2003, Psychological bulletin.

[32]  David A. Wise,et al.  Research Findings in the Economics of Aging , 2010 .

[33]  T. Buchmueller,et al.  Switching costs, price sensitivity and health plan choice. , 2002, Journal of health economics.

[34]  Charles A. Holt,et al.  Risk Aversion and Incentive Effects , 2002 .

[35]  M. Lepper,et al.  The Construction of Preference: When Choice Is Demotivating: Can One Desire Too Much of a Good Thing? , 2006 .

[36]  Terrance Odean.  Do Investors Trade Too Much? , 1998 .

[37]  F. Schut,et al.  Consumer Price Sensitivity and Social Health Insurer Choice in Germany and the Netherlands , 2003, International Journal of Health Care Finance and Economics.

[38]  R. Thaler,et al.  Nudge: Improving Decisions About Health, Wealth, and Happiness , 2008 .