Purpose: The standard gamble (SG) suffers from the biases probability weighting, loss aversion and scale compatibility. The effects of these biases on SG utilities are not conclusive, and more knowledge with respect to these biases is required. We aimed to determine the effect of these biases on SG utilities using qualitative data to locate the outcome that served as reference point and to assess the focus of attention. Methods: While thinking aloud, 45 healthy respondents provided SG utilities for six rheumatoid arthritis health states, based on the EQ5D classification system. The SG was computerized using the program Ci3. All elicitations were based on the choice bracketing procedure. Interviews were taped and transcribed. Reference point, goals, and focus of attention were coded by two independent coders. To assess the effect of scale compatibility on mean SG utility, correlations were assessed between focus of attention and mean utility. Results: The certain outcome, i.e. the health state that was valued, served most frequently as reference point, implying that the SG was perceived as a mixed gamble. Goals were mostly mentioned with respect to this certain outcome. Additionally, scale compatibility led to an upward bias in SG utilities, since the focus of attention lay relatively more on the low outcome and this was positively correlated with mean utility. Conclusions: It is important to at least correct SG utilities for loss aversion and probability weighting with the mixed correction formula proposed by prospect theory. Scale compatibility will likely then still bias the results to some extent, calling for more research on this bias to decide about possible correction.