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What factors influence seniors’ desire for choice among health insurance options? Survey results on the Medicare prescription drug benefit

Published online by Cambridge University Press:  01 October 2010

Thomas Rice ,
Yaniv Hanoch  and
Janet Cummings
Thomas Rice*
Affiliation:
Professor, Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA
Yaniv Hanoch
Affiliation:
Lecturer, University of Plymouth, School of Psychology, Drake Circus, Plymouth, UK
Janet Cummings
Affiliation:
Assistant Professor, Department of Health Policy and Management, Rollins School of Public Health, Atlanta, GA, USA
*
*Correspondence to: Thomas Rice, Vice Chancellor, Academic Personnel, UCLA, 2138 Murphy Hall, Los Angeles, CA 90095-1405, USA. Email: [email protected]
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Abstract

Questions about the design of the new US Medicare prescription drug benefit were raised even before its passage, where one of the most heated issues has been the number of plans offered to beneficiaries. Whether beneficiaries believe that there should be extensive or limited choice is still an open question. To study this issue, we analyzed data from the Kaiser Family Foundation/Harvard School of Public Health Survey, which included 718 individuals aged 65 years and above. The survey asked these older adults (i) whether they prefer having dozens of plans or for Medicare to offer a restricted number of plans and (ii) whether they think there are too many, too few or the right amount of plans. Our findings show that the majority of beneficiaries (69%) preferred that Medicare offer a limited number of options while only 29% wanted to see dozens of plans on the market. We also examine the effect of education level, income, political affiliation, race and health status on the desire for more or fewer plans. One surprising finding is that seniors with higher education appear to prefer fewer, not more, plan choices. Overall, our results question the merit of offering so many prescription drugs plan choices to Medicare beneficiaries.

Type
Articles
Information
Health Economics, Policy and Law , Volume 5 , Issue 4 , October 2010 , pp. 437 - 457
Copyright
Copyright © Cambridge University Press 2009

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References

Agency for Healthcare Research and Quality, CAHPS Overview (2009), https://www.cahps.ahrq.gov/content/cahpsOverview/OVER_Intro.asp?p=101&s=1 [6 April 2009].Google Scholar
Campbell, A. L., Morgan, K. J. (2007), ‘Policy Feedbacks and the Medicare Modernization Act of 2003: The Political Ramifications of Policy Change’, American Political Science Association Annual Meetings, Chicago.Google Scholar
Centers for Medicare & Medicaid Services (2008), ‘Lower Medicare Part D Costs than Expected in 2009, Beneficiary Satisfaction Remains High’, Press Release, August 14.Google Scholar
Centers for Medicare & Medicaid Services (2009), ‘Medicare Advantage/Part D Contract and Enrollment Data’, Analysis conducted for authors by J. Cubanski, Kaiser Family Foundation, March.Google Scholar
Finucane, M. L., Mertz, C. K., Slovic, P.Schmidt, E. S. (2005), ‘Task complexity and older adults’ decision-making competence’, Psychology and Aging, 20(1): 71–84.CrossRefGoogle ScholarPubMed
Fox, P. D., Snyder, R. E.Rice, T. (2003), ‘The Medigap reform legislation of 1990: a ten year review’, Health Care Financing Review, 24(3): 1–17.Google Scholar
Greene, J., Peters, E., Mertz, C. K.Hibbard, J. H. (2008), ‘Comprehension and choice of consumer-directed health plan: an experimental study’, The American Journal of Managed Care, 14(6): 369–376.Google ScholarPubMed
Gruber, J., Choosing a Medicare Part D Plan: Are Medicare Beneficiaries Choosing Low-Cost Plans?, Kaiser Family Foundation (2009), http://www.kff.org/medicare/upload/7864.pdf [March].Google Scholar
Hanoch, Y., Rice, T., Cummings, J.Wood, S. (2009), ‘How much choice is too much?: The case of the Medicare prescription drug benefit’, Health Services Research, 44: 1157–1168.CrossRefGoogle ScholarPubMed
Hibbard, J. H., Greene, J., Tussler, M. (2006), ‘An Assessment of Beneficiary Knowledge of Medicare Coverage Options and the Prescription Drug Benefit’, Report no. 20016-12. May, Public Policy Institute, American Association of Retired Persons, Washington, DC.Google Scholar
Hibbard, J. H.Jewett, J. J. (1997), ‘Will quality report cards help consumers?’, Health Affairs, 16(3): 218–228.CrossRefGoogle ScholarPubMed
Hibbard, J. H., Jewett, J. J., Engelmann, S.Tusler, M. (1998), ‘Can Medicare beneficiaries make informed choices?’, Health Affairs, 17(6): 181–193.CrossRefGoogle ScholarPubMed
Hibbard, J. H., Slovic, P., Peters, E., Finucane, M. L.Tusler, M. (2001), ‘Is the informed-choice policy approach appropriate for medicare beneficiaries?’, Health Affairs, 20(1): 199–203.CrossRefGoogle ScholarPubMed
Hoadley, J. (2008), ‘Medicare Part D: Simplifying the Program and Improving the Value of Information for Beneficiaries’, Issue Brief, May, The Commonwealth Fund, New York.Google Scholar
Hoadley, J., Thompson, J., Hargrave, E., et al., Premiums, Kaiser Family Foundation (2008), http://www.kff.org/medicare/upload/7706.pdf [November].Google Scholar
Iyengar, S. S.Lepper, M. R. (2000), ‘When choice is demotivating: can one desire too much of a good thing’, Journal of Personality and Social Psychology, 79: 995–1006.CrossRefGoogle ScholarPubMed
Kaiser Family Foundation, Selected Findings on Seniors’ Views of the Medicare Prescription Drug Benefit (2006), http://www.kff.org/kaiserpolls/7463.cfm [February].Google Scholar
Kaiser Family Foundation, The Medicare Prescription Drug Benefit: Fact Sheet (2009), http://www.kff.org/medicare/upload/7044-09.pdf [March].Google Scholar
Kyllonen, P. C.Christal, R. E. (1990), ‘Reasoning ability is (little more than) working-memory capacity?!’, Intelligence, 14(4): 389–433.CrossRefGoogle Scholar
Neuman, P., Strollo, M. K., Guterman, S., Rogers, W. H., Li, A., Rodday, A. M.Safran, D. G. (2007), ‘Medicare prescription drug benefit progress report: findings From a 2006 National Survey of seniors’, Health Affairs, 26(5): W630–W634.CrossRefGoogle ScholarPubMed
Obama–Biden (2009), http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf [6 April 2009].Google Scholar
Oliver, T. R., Lee, P. R.Lipton, H. L. (2004), ‘A political history of Medicare and prescription drug coverage’, Milbank Quarterly, 82(2): 283–354.Google ScholarPubMed
Peters, E. M., Dieckmann, N., Dixon, A., Hibbard, J. H.Mertz, C. K. (2007), ‘Less is more in presenting quality information to consumers’, Medical Care Research and Review, 64(2): 169–190.Google ScholarPubMed
Public Agenda, Seven in 10 Americans Say the Medicare Prescription Drug Benefit is Too Complicated but Majorities Say it Helps People Save Money and is Especially Helpful for Low-Income People (2009), http://www.publicagenda.org/charts/seven-10-americans-say-medicare-prescription-drug-benefit-too-complicated-majorities-say-it-helps-people-save [17 April 2009].Google Scholar
Rammsayer, T. H.Brandler, S. (2007), ‘Performance on temporal information processing as an index of general intelligence’, Intelligence, 35(2): 123–139.CrossRefGoogle Scholar
Reutskaja, E.Hogarth, R. M. (2009), ‘Satisfaction in choice as a function of the number of alternatives: when “goods satiate” ’, Psychology and Marketing, 26(3): 197–203.CrossRefGoogle Scholar
Rice, T., Cummings, J. R., Kao, D. (2008), ‘Reducing the Number of Drug Plans for Seniors: A Proposal and Analysis of Three Case Studies’, Presented at the AcademyHealth Annual Meeting, 9 June 2008, Washington, DC.Google Scholar
Schwartz, B. (2000), ‘Self determination: the tyranny of freedom’, American Psychologist, 55(1): 79–88.CrossRefGoogle ScholarPubMed
Schwartz, B. (2004), The paradox of choice: why more is less, New York, NY: HarperCollins.Google Scholar
Schwartz, B., Ward, A., Monterosso, J., Lyubomirsky, S., White, K.Lehman, D. R. (2002), ‘Maximizing versus satisficing: happiness is a matter of choice’, Journal of Personality and Social Psychology, 83(5): 1178–1197.CrossRefGoogle ScholarPubMed
Sethi-Iyengar, S., Huberman, G.Jiang, J. (2004), ‘How much choice is too much? Contributions to 401(k) retirement plans?’, in Mitchell, O. S. and S. Utkus (eds), Pension Design and Structure: New Lessons from Behavioral Finance, Oxford, UK: Oxford University Press, 83–95.CrossRefGoogle Scholar
Shah, A. M.Wolford, G. (2007), ‘Buying behavior as a function of parametric variation of number of choices’, Psychological Sciences, 18(5): 369–370.CrossRefGoogle ScholarPubMed
Simon, H. A. (1955), ‘A behavioral model of rational choice’, Quarterly Journal of Economics, 69: 99–118.CrossRefGoogle Scholar
Simon, H. A. (1956), ‘Rational choice, and the structure of the environment’, Psychological Review, 63: 129–138.CrossRefGoogle ScholarPubMed
Thaler, R. H.Sunstein, C. R. (2003), ‘Libertarian paternalism’, American Economic Review, 93(2): 175–179.CrossRefGoogle Scholar
Thaler, R. H.Sunstein, C. R. (2008), Nudge: Improving Decisions about Health, Wealth, and Happiness, New Haven, CT: Yale University Press.Google Scholar
Thornton, W. J. L.Dumke, H. A. (2005), ‘Age differences in everyday problem-solving and decision-making effectiveness: a meta-analytic review’, Psychology and Aging, 20(1): 85–99.CrossRefGoogle ScholarPubMed
US Census Bureau, Statistical Abstract of the United States. Table 214 (2005), http://www.census.gov/prod/2004pubs/04statab/educ.pdfGoogle Scholar
Waxman, H. A. , Pharmaceutical Industry Profits Increase by Over $8 Billion After Medicare Drug Plan Goes Into Effect (2006), http://oversight.house.gov/documents/20060919115623-70677.pdf [17 April 2009].Google Scholar