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Choice cuts: parsing policymakers’ pursuit of patient empowerment from an individual perspective

Published online by Cambridge University Press:  01 July 2010

Mark Schlesinger
Mark Schlesinger*
Affiliation:
Professor, Division of Health Policy and Administration, Yale School of Public Health, Yale University, New Haven, CT, USA
*
*Correspondence to: Professor Mark Schlesinger, Division of Health Policy and Administration, Yale School of Public Health, Yale University, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, USA. Email: [email protected]
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Abstract

In this commentary I explore several ways in which the psychology of individual decision-making shapes consumers’ choices in medical settings and the potential for choice-based policies to improve the performance of the health care system. This analysis draws some crucial distinctions among the various pathways though which policymakers expect choice to improve outcomes and the various forms of support that might enhance patients’ engagement with choice. I also consider how choice-promoting policies interact with other strategies for patient empowerment and depend crucially on the ways in which individual patients develop the capacity to make sense of their experiences with medical care. Drawing largely on data and studies from medical consumerism in the US, I identify a number of choice ‘pathologies’ that might compromise the influence or beneficial effects of choice-promoting initiatives. Though these limitations are unlikely to turn public officials away from their consumerist policy aspirations, identifying the realistic limitations of such initiatives makes clear the need to complement them with other strategies for enhancing patients’ well being and encouraging a more responsive health care system.

Type
Commentary
Information
Health Economics, Policy and Law , Volume 5 , Issue 3: Special Issue on Cross-Country Issues in Health Care: Choice, Equity, Efficiency and Cost , July 2010 , pp. 365 - 387
Copyright
Copyright © Cambridge University Press 2010

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References

Anderson, C. (2003), ‘The psychology of doing nothing: forms of decision avoidance result from reason and emotion’, Psychological Bulletin, 129(1): 139–166.CrossRefGoogle ScholarPubMed
Annas, G. J. (1997), ‘ “Patients” rights in managed care – exit, voice, and choice’, New England Journal of Medicine, 337(3): 210–215.Google Scholar
Ariely, D. (2008), Predictably Irrational: The Hidden Forces That Shape Our Decisions, New York: HarperCollins.Google Scholar
Armor, D.Taylor, S. (2002), ‘When Predictions Fail: The Dilemma of Unrealistic Optimism’, in Thomas G. D. Griffin and D. Kahneman (eds), Heuristics and Biases: The Psychology of Intuitive Judgment, New York: Cambridge University Press: 334–347.CrossRefGoogle Scholar
Bevan, G., Helderman, J.-K., Wilsford, D. (2010), ‘Changing Choices in Health Care: Implications for Equity, Efficiency and Cost’, Health Economics, Policy and Law, 5: 251–267.Google Scholar
Bevan, G., van de Ven, W. P. M. M. (2010), ‘Choice of Providers and Mutual Healthcare Purchasers: can the English NHS Learn From the Dutch reforms?’, Health Economics, Policy and Law, 5: 343–363.CrossRefGoogle Scholar
Bodenheimer, T. (2008), ‘Coordinating care – a perilous journey through the health care system’, New England Journal of Medicine, 358(10): 1064–1071.Google Scholar
Bowles, A., Tuzzio, E., Wiese, L., Kirlin, C. J., Greene, B., Clauser, S. M.Wagner, E. H. (2008), ‘Understanding high-quality cancer care: a summary of expert perspectives’, Cancer, 112(4): 934–942.Google Scholar
Bradley, M. M., Lang, P. J. (1999). ‘Affective Norms for English Words (ANEW): Stimuli, Instruction Manual and Affective Ratings’, Technical Report C-1, Gainesville, FL. The Center for Research in Psychophysiology, University of Florida.Google Scholar
Brafman, O.Brafman, R. (2008), Sway: The Irresistible Pull of Irrational Behavior, New York: Broadway Books.Google Scholar
Caplin, A.Eliaz, K. (2003), ‘AIDS and psychology: a mechanism-design approach’, RAND Journal of Economics, 34(4): 631–646.Google Scholar
Chernew, M., Gowrisankaran, G.Scanlon, D. (2001), ‘Learning and the Value of Information: The Case of Health Plan Report Cards NBER Working Paper No. 8589’, Cambridge MA, National Bureau of Economic Research.Google Scholar
Commonwealth Fund (2007), The Commonwealth Fund 2007 International Health Policy Survey of Sicker Adults, New York: Commonwealth Fund.Google Scholar
Conlisk, J. (1996), ‘Why bounded rationality?’, Journal of Economic Literature, 34(2): 669–700.Google Scholar
Conway, M.Ross, M. (1984), ‘Getting what you want by revising what you had’, Journal of Personality and Social Psychology, 47(4): 738–748.Google Scholar
Corrigan, P.Maynard, A. (2005), ‘The HSJ debate. Patient choice is an effective lever for change in primary care’, Health Service Journal, 115(5983): 18–19.Google ScholarPubMed
Coulter, A.Jenkinson, C. (2005), ‘European patients’ views on the responsiveness of health systems and healthcare providers’, European Journal of Public Health, 15(4): 355–360.CrossRefGoogle ScholarPubMed
de Ruyter, K.Wetzels, M. (1998), ‘On the complex nature of patient evaluation of general practitioner service’, Journal of Economic Psychology, 19: 565–590.Google Scholar
Darby, C., Crofton, C.Clancy, C. M. (2006), ‘Consumer assessment of health providers and systems (CAHPS®): evolving to meet stakeholder needs’, American Journal of Medical Quality, 21(2): 144–147.CrossRefGoogle ScholarPubMed
Davenport-Ennis, N. (2008), ‘Access to Healthcare: Using Data from a Nonprofit Advocacy Practice to Drive Policy Change’, in J. A. Earp, E. French and M. Gilkey (eds), Patient Advocacy for Health Care Quality, Boston: Jones and Bartlett, 419–444.Google Scholar
Davis, K., Collins, K. S., Schoen, C.Morris, C. (1995), ‘Choice matters: enrollees’ views of their health plans’, Health Affaires, 14(2): 99–112.CrossRefGoogle ScholarPubMed
Dhar, R.Nowlis, S. (2004), ‘To buy or not to buy: response mode effects on consumer choice’, Journal of Marketing Research, 41(4): 423–432.Google Scholar
Dhar, R., Nowlis, S.Sherman, S. (1999), ‘Comparison effects on preference construction’, Journal of Consumer Research, 26(3): 293–306.Google Scholar
Dixon, A., Robertson, R., Dixon, R. (2010), ‘The Experience of Implementing Choice at Point of Referral: A Comparison of the Netherlands and England’, Health Economics, Policy and Law, 5: 295–317.CrossRefGoogle ScholarPubMed
Dohan, D.Schrag, D. (2005), ‘Using navigators to improve care of underserved patients: current practices and approaches’, Cancer, 104(4): 848–855.CrossRefGoogle ScholarPubMed
Elbel, B.Schlesinger, M. (2009), ‘A neglected aspect of medical consumerism: responsive consumers in markets for health plans’, Milbank Quarterly, 87(3): 633–682.CrossRefGoogle ScholarPubMed
Evans, D., Powell, J.Cross, T. (2008), ‘Patient advice and liaison services: results of an audit survey in England’, Health Expectations, 11: 304–316.CrossRefGoogle ScholarPubMed
Ferrante, J. M., Chen, P. H.Kim, S. (2008), ‘The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: a randomized controlled trial’, Journal of Urban Health, 85(1): 114–124.CrossRefGoogle ScholarPubMed
Flood, C. M., Haugan, A. (2010), ‘Lessons for Canada from Regulatory Approaches to the Public/Private Divide in Sweden, the UK, the Netherlands, Germany and France’, Health Economics, Policy and Law, 5: 319–341.Google Scholar
Frostin, P. (2008), Findings from the 2008 EBRI Consumer Engagement in Health Care Survey EBRI Issue Brief No. 323, Washington DC: Employee Benefits Research Institute.Google Scholar
Fung, C., Elliot, M., Hays, R., Kahn, K., Kanouse, D., Glynn, E., Spranca, M.Shekelle, P. (2005), ‘ “Patients” preferences for technical versus interpersonal quality when selecting a primary care physician’, Health Services Research, 40(4): 957–977.Google Scholar
Gilbert, D., Pinel, E., Wilson, T., Blumberg, S.Wheatley, T. (2002), ‘Durability Bias in Affective Forecasting’, in T. Gilovich, D. Griffin and D. Kahneman (eds.), Heuristics and Biases: The Psychology of Intuitive Judgment, New York: Cambridge University Press: 292–312.Google Scholar
Grytten, J.Sørensen, R. J. (2009), ‘Patient choice and access to primary physician services in Norway health economics’, Policy and Law, 4(1): 11–27.Google Scholar
Hale, J. L.Dillard, J. P. (1995), ‘Fear Appeals in Health Campaigns: Too Much, Too Little, or Just Right?’, in E. Maibach and R. Parrott (eds), Designing Health Messages, Thousand Oaks: Sage Publications: 65–80.Google Scholar
Hanoch, Y.Rice, T. (2006), ‘Can limiting choice increase social welfare? The elderly and health insurance’, Milbank Quarterly, 84: 37–73.CrossRefGoogle ScholarPubMed
Hawkins, S.Hastie, R. (1990), ‘Hindsight: biased judgments of past events after the outcomes are known’, Psychological Bulletin, 107(3): 311–327.CrossRefGoogle Scholar
Hibbard, J. H., Slovic, P., Peters, E. M.Finucane, M. (2002), ‘Strategies for reporting health plan performance information to consumers: evidence from controlled studies’, Health Services Research, 37(2): 291–313.Google Scholar
Hibbard, J. H., Greene, J.Tusler, M. (2008), ‘Plan design and active involvement of consumers in their own health and healthcare’, American Journal of Managed Care, 14(11): 729–736.Google Scholar
Hsu, J., Schmittdiel, J., Krupat, E., Stein, T., Thom, D., Fireman, B.Selby, J. (2003), ‘Patient choice: a randomized control trial of provider selection’, Journal of General Internal Medicine, 18: 319–325.CrossRefGoogle Scholar
Isen, A.Labroo, A. (2003), ‘Some Ways in Which Positive Affect Facilitates Decision Making and Judgment’, in S. Schneider and J. Shanteau (eds), Emerging Perspectives on Judgment and Decision Research, New York: Cambridge University Press: 365–393.Google Scholar
Iyengar, S.Lepper, M. (2000), ‘When choice is demotivating: can one desire too much of a good thing?’, Journal of Personality and Social Psychology, 79(6): 995–1006.CrossRefGoogle ScholarPubMed
Jacobs, L. R.Shapiro, R. Y. (1994), ‘A questioning the conventional wisdom on public opinion toward health reform at PS’, Political Science and Politics, 27(2): 208–214.Google Scholar
Jennings, B. (2007), ‘Autonomy’, in B. Steinbock (ed.), The Oxford Handbook of Bioethics, New York: Oxford University Press: 72–89.Google Scholar
Johnson, E., Hershey, J., Meszaros, J.Kunreuther, H. (1993), ‘Framing, probability distortions and insurance decisions’, Journal of Risk and Uncertainty, 7(1): 35–51.Google Scholar
Kahneman, D.Frederick, S. (2002), ‘Representativeness Revisited: Attribute Substitution in Intuitive Judgment’, in T. Gilovich, D. Griffin and D. Kahneman (eds), Heuristics and Biases: The Psychology of Intuitive Judgment, New York: Cambridge University Press: 49–81.CrossRefGoogle Scholar
Kaiser Family Foundation (2008), 2008 Update on Consumers’ Views of Patient Safety and Quality Information Publication No. 7819, Menlo Park, CA: Henry J Kaiser Family Foundation.Google Scholar
Kaiser Family Foundation (2004), National Survey on Consumers Experiences with Patient Safety and Quality Information, Menlo Park, CA: Henry J. Kaiser Family Foundation.Google Scholar
Kalda, R., Polluste, K.Lember, M. (2003), ‘Patient satisfaction with care is associated with personal choice of physician’, Health Policy, 64(1): 55–62.CrossRefGoogle ScholarPubMed
Klein, R. (2007), ‘The new model NHS: performance, perceptions and expectations’, British Medical Bulletin, 81–82: 39–50.CrossRefGoogle Scholar
Köszegi, B. (2003), ‘Health, anxiety and patient behavior’, Journal of Health Economics, 22(6): 1073–1084.CrossRefGoogle ScholarPubMed
Kroneman, M. W., Maarse, H.van der Zee, J. (2006), ‘Direct access in primary care and patient satisfaction: a European study’, Health Policy, 76(1): 72–79.Google Scholar
Lerman, C., Hughes, C., Trock, B. J., Myers, R. E., Main, D., Bonney, A., Abbaszadegan, M. R., Harty, A. E., Franklin, B. A., Lynch, J. F.Lynch, H. T. (1999), ‘Genetic testing in families with hereditary nonpolyposis colon cancer’, Journal of the American Medical Association, 281(17): 1618–1622.Google Scholar
Lerman, C., Narod, S., Schulman, K., Hughes, C., Gomez-caminero, A., Bonney, G., Gold, K., Trock, B., Main, D., Lynch, J., Fulmore, C., Snyder, C., Lemon, S. J., Conway, T., Tonin, P., Lenoir, G.Lynch, H. (1996), ‘BRCA1 testing in families with hereditary breast-ovarian cancer. A prospective study of patient decision making and outcomes’, Journal of the American Medical Association, 275(24): 1885–1892.Google Scholar
Loewenstein, G. (2004), ‘Out of Control: Visceral Influences on Behavior’, in C. Camerer, G. Lowenstein and M. Rabin (eds.), Advances in Behavioral Economics, New York and Princeton: Russell Sage Foundation and Princeton University Press: 689–723.Google Scholar
Loewenstein, G., Weber, E., Hsee, C.Welch, N. (2001), ‘Risk as feelings’, Psychological Bulletin, 127(2): 267–268.CrossRefGoogle ScholarPubMed
McCormack, L. A., Schnaier, J. A., Lee, A. J.Garfinkel, S. A. (1996), ‘Medicare beneficiary counseling programs: what are they and do they work?’, Health Care Financing Review, 18(1): 127–140.Google Scholar
Maxwell, J.Temin, P. (2002), ‘Managed competition versus industrial purchasing of health care among the fortune 500’, Journal of Health Politics, Policy and Law, 27(1): 5–30.CrossRefGoogle ScholarPubMed
Milstein, A.Adler, N. (2003), ‘Out of sight, out of mind: why doesn’t widespread clinical quality failure command our attention?’, Health Affairs, 22(2): 119–127.CrossRefGoogle ScholarPubMed
Nemko, M. (2007). ‘Ahead of the Curve: Patient Advocate’, US News and World Report (December 19)’.Google Scholar
Nichols, L., et al. (2004), ‘Are market forces strong enough to deliver efficient health care systems? confidence is waning’, Health Affairs, 23(2): 8–21.CrossRefGoogle ScholarPubMed
Noll, R.Krier, J. (1990), ‘Some implications of cognitive psychology for risk regulation’, Journal of Legal Studies, 19: 747–749.Google Scholar
O’Cathain, A., Goode, J., Luff, D., Strangleman, T., Hanlon, G.Greatbatch, D. (2005), ‘Does NHS direct empower patients?’, Social Science & Medicine, 61(8): 1761–1771.Google Scholar
Or, Z., Cases, C., Lisac, M., Vrangbæk, K., Ulrika Winblad Spångberg, Bevan (2010), ‘Are Health Problems Systemic? Health Reforms Under Beveridgian and Bismarkian Systems’, Health Economics, Policy and Law, 5: 269–293.Google Scholar
Paulus, A., et al. (2003), ‘Market competition: everybody is talking, but what do they say? A sociological analysis of market competition in policy networks’, Health Policy, 64: 279–289.Google Scholar
Rabin, M.Schrag, J. (1999), ‘First impressions matter: a model of confirmatory bias’, Quarterly Journal of Economics, 114(1): 37–82.CrossRefGoogle Scholar
Robinson, J. C.Ginsburg, P. B. (2009), ‘Consumer-driven health care: promise and performance’, Health Affairs, 28(2): w272–w281.CrossRefGoogle ScholarPubMed
Rothman, A.Salovey, P. (1997), ‘Shaping perceptions to motivate healthy behavior: the role of message framing’, Psychological Bulletin, 121(1): 3–19.CrossRefGoogle ScholarPubMed
Sage, W. (2000), Accountability Through Information: What the Health Care Industry Can Learn From Securities Regulation, New York: Milbank Memorial Fund.Google Scholar
Schlesinger, M. (2005), ‘The Dangers of the Market Panacea’, in J. Morone and L. Jacobs (eds), Healthy, Wealthy and Fair, New York: Oxford University Press: 91–136.Google Scholar
Schlesinger, M., Druss, B.Thomas, T. (1999), ‘No exit? The effect of health status on dissatisfaction and disenrollment from health plans’, Health Services Research, 34(2): 547–576.Google Scholar
Schlesinger, M., Mitchell, S.Elbel, B. (2002), ‘Voices unheard: barriers to the expression of dissatisfaction with health plans’, Milbank Quarterly, 80(4): 709–755.Google Scholar
Schneider, C. (2006), ‘After autonomy’, Wake Forest Law Review, 41: 411–444.Google Scholar
Schoen, C., Osborn, R., Huynhm, P. T., Doty, M., Zapert, K., Peugh, J.Davis, K. (2005), ‘Taking the pulse of health care systems: experiences with health problems in six countries’, Health Affairs (Web Exclusive), W 5: 510–523.Google Scholar
Schoen, C., Osborn, R., Doty, M., Bishop, M., Peugh, J.Murukutla, N. (2007), ‘Toward higher-performance health care systems: adults health care experiences in seven countries, 2007’, Health Affairs (Web Exclusive), W 7: 717–734.CrossRefGoogle Scholar
Schoen, C., Osborn, R., How, S., Doty, M., Peugh, J. (2008). ‘In Chronic Condition: Experiences of Patients With Complex Health Needs in Eight Countries’, Health Affairs, 28(1): w1–w16.Google ScholarPubMed
Schwartz, N. (2002), ‘Feelings as Information: Moods Influence Judgments and Processing Strategies’, in T. Gilovich, D. Griffin and D. Kahneman (eds), Heuristics and Biases: The Psychology of Intuitive Judgment, New York: Cambridge University Press: 534–547.Google Scholar
Simon, H. (1957), Models of Man: Social And Rational; Mathematical Essays on Rational Human Behavior in a Social Setting, New York: Wiley.Google Scholar
Simon, H. (1982), Models of Bounded Rationality, Cambridge, MA: MIT Press.Google Scholar
Slovic, P., Finucane, M., Peters, E.MacGregor, D. (2002), ‘The Affect Heuristic’, in T. Gilovich, D. Griffin and D. Kahneman (eds), Heuristics and Biases: The Psychology of Intuitive Judgment, New York: Cambridge University Press, 397–420.Google Scholar
Sniderman, P., Brody, R.Tetlock, P. (1991), Reasoning and Choice: Explorations in Political Psychology, New York: Cambridge University Press.Google Scholar
Spranca, M., Eliot, M., Shaw, R.Kanouse, D. (2007), ‘Disenrollment information and medicare plan choice: is more information better?’, Health Care Financing Review, 28(3): 47–59.Google ScholarPubMed
Sunstein, C. (2002), ‘Probability neglect: emotions, worst cases and the law’, Yale Law Journal, 112(1): 61–107.Google Scholar
Thaler, R. (1999), ‘Mental accounting matters’, Journal of Behavioral Decision-making, 12(2): 183–206.Google Scholar
Thaler, R.Sunstein, C. (2008), Nudge: Improving Decisions About Health, Wealth and Happiness, New Haven: Yale University Press.Google Scholar
Tiedens, L.Linton, S. (2001), ‘Judgment under emotional certainty and uncertainty: the effects of specific emotions on information processing’, Journal of Personality and Social Psychology, 81(6): 973–988.Google Scholar
Tomes, N. (2006), ‘Patients or health-care consumers? Why the history of contested terms matters’, in R. Stevens, C. Rosenberg and L. Burns (eds), History and Health Policy in the United States, New Brunswick, NJ: Rutgers University Press: 83–110.Google Scholar
Tu, H.May, J. (2007), ‘Self-pay markets in health care: consumer nirvana or caveat emptor?’, Health Affairs, 26(2): w217–w226.Google Scholar
Vaiana, M.McGlynn, E. (2002), ‘What cognitive science tells us about the design of reports for consumers’, Medical Care Research and Review, 59(1): 3–35.Google Scholar
van de Ven, W. P. M. M., Beck, K., Van de Voorde, C., Wasem, J.Zmora, I. (2007), ‘Risk adjustment and risk selection in Europe: 6 years later, Health Policy, 83(2): 162–179.CrossRefGoogle ScholarPubMed
Van Dijk, W., Zeelenberg, M.van der Pligt, J. (2003), ‘Blessed are those who expect nothing: lowering expectations as a way of avoiding disappointment’, Journal of Economic Psychology, 24(4): 505–516.Google Scholar
Van Hecke, M. (2007), Blind Spots: Why Smart People Do Dumb Things, Boston MA: Prometheus Books.Google Scholar
Weiner, B. (1995), Judgments of Responsibility, New York: Guilford Press.Google Scholar
Weinstein, N.Klein, W. (1995), ‘Resistance of personal risk perceptions to debiasing interventions’, Health Psychology, 14(2): 132–140.Google Scholar
Witte, K.Allen, M. (2000), ‘A meta-analysis of fear appeals: implications for effective public health campaigns’, Health Education and Behavior, 27(5): 591–615.Google Scholar