Purpose: We compare the monetary and health risk preferences of two groups of cardiovascular patients undergoing nuclear stress tests. For some subjects, the choices presented in the health risk preferences instrument were purely hypothetical. For other subjects, who had experienced either angina or shortness of breath, the health scenarios instrument was tailored to their symptom and its frequency. Methods: Subjects completed instruments to measure risk preferences over monetary and health outcomes after answering questions asking whether and with what frequency they have had angina or shortness of breath. The monetary risk preferences instrument consisted of twelve $5 lotteries. Certainty equivalents for each lottery were elicited; subjects were paid their earnings in cash. The health risk preferences instrument was framed in terms of drugs that could potentially treat the symptom of interest (angina or shortness of breath). For patients who had experienced one of the symptoms recently, the choice scenarios were specifically tailored to both their symptom and its frequency. Individuals who had experienced neither symptom were given a description of what an angina attack feels like and asked to respond to the choice scenarios supposing they were experiencing angina attacks twice weekly. Each health scenario involved a choice between Drug A, with an x% probability of eradicating their symptom and a (1-x)% probability of having no effect, and Drug B, which would reduce the frequency of the symptom's occurrence by x%.

Results: Seventy-nine patients who presented for stress testing participated in this preliminary study. Of these, thirty had experienced shortness of breath and/or angina. We found a significant difference between the risk preferences of subjects who answered the hypothetical scenarios and subjects who were responding to scenarios based on the frequency of their own symptoms. Subjects with angina or shortness of breath made more risk averse choices, choosing the risky drug in 24.2% of the scenarios, while individuals who had experienced neither of these symptoms chose the risky drug in 46.99% of the scenarios (p<.01). As expected, there was no significant difference in the monetary risk preferences of the two groups of subjects (p=.44).

Conclusions: While risk preferences differ over health and monetary choices, they also depend upon whether the health choices subjects are asked to make are based on real or hypothetical symptoms.