LOOKING IN ALL THE WRONG PLACES: DEFICITS IN INFORMATION SEARCH BEHAVIOR RESULTS IN SUBOPTIMAL HEALTH PLAN SELECTION

Purpose:

Previous research on choice architecture suggests that consumers will have a difficult time choosing an optimal healthcare plan with the current structure of healthcare.gov (e.g. Barnes et al., 2012). This research is designed to examine how choice complexity in this naturalistic context influences information search and subsequent decision quality.

Method:

Across three studies, participants read a series of hypothetical vignettes describing individuals or families with specific healthcare needs. Their task was to select the optimal healthcare plan (lowest cost, while accounting for health history) for each individual/family from a set of three plans. For each vignette, participants viewed the health plan choices in an option (i.e., plan) by attribute (e.g., deductible) grid similar to the ‘compare plans' function on healthcare.gov.  

In Study 1 and 2, participants (Internet sample recruited via Amazon Mechanical Turk, N=201, and college students, N=200), completed this task for four vignettes. In Study 3, college students (N=159) completed the task with only two vignettes but this time viewed the plans using MouselabWEB, an interactive table that displays option by attribute information and tracks search behavior. We hypothesized that: 1) accuracy in health plan selection would decrease with choice complexity; and 2) increased search of relevant information would increase task accuracy.

Results:

For Study 1 and 2, participants' ability to choose the optimal healthcare plan decreased as the complexity of the health history increased, X²(3) = 127.88, p<.001.  For example, in Study 1, the majority of participants (70%) chose the optimal plan for an individual with few healthcare needs, while only 25% of participants were able to choose the optimal plan for the family with the greatest healthcare needs.

In Study 3, search behavior predicted task accuracy. Participants who correctly identified the optimal health plans adopted a search strategy focused on the most relevant information for each vignette, whereas those who could not identify the optimal plan used a more diffuse search strategy (Figure 1).

Conclusions:

A large portion of the population may be ill equipped to choose optimal health plans, and the amount of information within a health plan may be a distraction to consumers. Choosing health plans that do not fit individual needs may lead to overpayment for some consumers and avoidance of care due to unexpected cost for others.