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Le Clainche C, Marsaudon A, Rochaix L, Haon B, Vergnaud JC. Do Behavioral Characteristics Influence the Breast Cancer Diagnosis Delay? Evidence From French Retrospective Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02747-5. [PMID: 38977186 DOI: 10.1016/j.jval.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 05/21/2024] [Accepted: 06/14/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES This study aimed to analyze the behavioral determinants of breast cancer (BC) diagnosis delays in France. To do so, we investigated whether time discounting, risk tolerance, and personality traits influenced the BC diagnosis delay of patients. METHODS We used original retrospective data collected on 2 large online patient networks from 402 women diagnosed of BC. The BC diagnosis delay was measured by the difference between the date of diagnosis and the date of first symptoms. Time discounting and risk tolerance are measured with both self-reported questions and hypothetical lotteries. Personality traits are measured with the 10-item Big Five indicator. Ordinary least square and probit models were used to analyze whether these behavioral characteristics influenced the BC diagnosis delay. RESULTS Results showed that risk tolerance and time discounting were not significantly associated with the BC diagnosis delay. However, we found a longer diagnosis delay for women with a neuroticism personality trait (standardized coefficients ranged from 0.104 [P-value = .036] to 0.090 [P-value = .065]). CONCLUSIONS Overall, our findings underline the need for an increased consideration of cancer screening public health policy for women with mental vulnerabilities since such vulnerabilities were found to be highly correlated with a neuroticism personality trait.
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Affiliation(s)
- Christine Le Clainche
- CNRS, IESEG School of Management, UMR 9221 - LEM - Lille Economie Management, Lille University, Lille, France.
| | - Antoine Marsaudon
- Institute for Research and Information in Health Economics (Irdes), Paris, France
| | - Lise Rochaix
- Paris I Panthéon-Sorbonne University and Hospinnomics (Greater Paris University Hospitals and Paris School of Economics Research Chair), Paris, France
| | - Baptiste Haon
- Hospinnomics (Greater Paris University Hospitals and Paris School of Economics Research Chair), Paris, France
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2
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Lu J, Dong Y, Zhang X, Wang Y, Zhou Z. The relationship between public risk preference and the underuse or overuse of preventive health services in the information age. Prev Med Rep 2024; 41:102727. [PMID: 38633208 PMCID: PMC11021990 DOI: 10.1016/j.pmedr.2024.102727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
The underuse or overuse of preventive health services by individuals is an outward behavioural reflection of their attitude towards disease risk, and they are strongly influenced by their information-acquisition ability. Therefore, we try to explore the relationship among the public risk preference, information-acquisition ability and underuse or overuse of preventive health services, in order to provide decision-making basis in the Information Age. The survey surveyed 2,211 respondents aged ≥ 18 in China from September to December 2019. Taking cancer screening as an example, the multiple price list (MPL) test and item response theory (IRT) model were used to measure individual risk preference and information-acquisition ability. The Logit model and Tobit model were used to estimate the relationship between risk preference, information-acquisition ability and underuse or overuse of preventive health services. Risk-seeking individuals were more likely to underuse preventive health services, while risk-averse individuals were more likely to overuse such services. Information-acquisition ability may improve the underuse of preventive health services in risk-seeking individuals but exacerbate the overuse of preventive health services in risk-averse individuals. Among the investigated information channels, the Internet is the most effective way for the public to obtain information. It is necessary to change the public's incorrect perception of disease risks and risks associated with preventive health services. In the rapid development of the Information Age, improving public information-acquisition ability is a practicable way to correct the negative relationship between risk preference and individuals' underuse or overuse of preventive health services.
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Affiliation(s)
- Jiao Lu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yanan Dong
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaoxiao Zhang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yuan Wang
- School of Management, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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3
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Finocchiaro Castro M, Lisi D, Romeo D. Experimental evidence on the role of shared protocols as coordination device on clinical best practices. Sci Rep 2024; 14:9363. [PMID: 38654112 DOI: 10.1038/s41598-024-60186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
Our experiment assesses the level of coordination on clinical best practice among physicians and investigates whether the release of guidelines helps in supporting coordination. Based on three clinical vignettes using current national guidelines, physicians evaluate the appropriateness of each of the proposed courses of action. Afterwards, physicians are allowed to ask which action corresponds to national guidelines and change their ratings, if desired. On average, slightly more than half of the sample coordinated on appropriateness evaluations. Empirical analysis indicates that several organizational and individual variables influence the level of coordination. Additionally, the release of national guidelines improved both the level of conformity and coordination. Our findings suggest changes in implementation practices to increase the impact of these shared protocols in the health field.
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Affiliation(s)
- Massimo Finocchiaro Castro
- Department of Law, Economics and Social Science, Mediterranean University of Reggio Calabria, Reggio Calabria, Italy
- Health Econometrics and Data Group, University of York, York, UK
- Institute for Corruption Studies, Illinois State University, Normal, USA
| | - Domenico Lisi
- Health Econometrics and Data Group, University of York, York, UK.
- Department of Economics and Business, University of Catania, Catania, Italy.
| | - Domenica Romeo
- Health Econometrics and Data Group, University of York, York, UK
- Department of Economics and Business, University of Catania, Catania, Italy
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4
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Mulligan K, Baid D, Doctor JN, Phelps CE, Lakdawalla DN. Risk preferences over health: Empirical estimates and implications for medical decision-making. JOURNAL OF HEALTH ECONOMICS 2024; 94:102857. [PMID: 38232447 DOI: 10.1016/j.jhealeco.2024.102857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
Mainstream health economic theory implies that an expected gain in health-related quality of life (HRQoL) produces the same value for consumers, regardless of baseline health. Several strands of recent research call this implication into question. Generalized Risk-Adjusted Cost-Effectiveness (GRACE) demonstrates theoretically that baseline health status influences value, so long as consumers are not risk-neutral over health. Prior empirical literature casts doubt on risk-neutral expected utility-maximization in the health domain. We estimate utility over HRQoL in a nationally representative U.S. population and use our estimates to measure risk preferences over health. We find that individuals are risk-seeking at low levels of health, become risk-averse at health equal to 0.485 (measured on a 0-1 scale), and are most risk-averse at perfect health (coefficient of relative risk aversion = 4.51). We develop the resulting implications for medical decision making, cost-effectiveness analyses, and the proper theory of health-related decision making under uncertainty.
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Affiliation(s)
- Karen Mulligan
- Sol Price School of Public Policy, University of Southern California, Ralph and Goldy Lewis Hall 312, Los Angeles, CA, 90089, USA; Schaffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, Los Angeles, CA, 90089, USA
| | - Drishti Baid
- Sol Price School of Public Policy, University of Southern California, Ralph and Goldy Lewis Hall 312, Los Angeles, CA, 90089, USA
| | - Jason N Doctor
- Sol Price School of Public Policy, University of Southern California, Ralph and Goldy Lewis Hall 312, Los Angeles, CA, 90089, USA; Schaffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, Los Angeles, CA, 90089, USA
| | - Charles E Phelps
- Department of Economics, University of Rochester, 238 Harkness Hall, 280 Hutchison Road, Box 270156, Rochester, NY, 14627, USA
| | - Darius N Lakdawalla
- Sol Price School of Public Policy, University of Southern California, Ralph and Goldy Lewis Hall 312, Los Angeles, CA, 90089, USA; Schaffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, Los Angeles, CA, 90089, USA; School of Pharmacy, University of Southern California, 1985 Zonal Ave, Los Angeles, CA, 90089, USA.
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5
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Thomas R, Galizzi MM, Moorhouse L, Nyamukapa C, Hallett TB. Do risk, time and prosocial preferences predict risky sexual behaviour of youths in a low-income, high-risk setting? JOURNAL OF HEALTH ECONOMICS 2024; 93:102845. [PMID: 38103348 DOI: 10.1016/j.jhealeco.2023.102845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
Young people in sub-Saharan Africa are particularly at high risk of sexually transmitted infections. Little is known about their preferences and even less about their association with risky sexual behaviour. We conducted incentivized economic experiments to measure risk, time and prosocial preferences in Zimbabwe. Preferences measured at baseline predict biomarker and self-reported measures of risky sexual behaviour gathered 12 months later. We find robust evidence that individuals more altruistic at baseline are more likely to be Herpes Simplex Virus Type-2 (HSV-2) positive 12 months later. Analysis by sex shows this association is driven by our sample of women. Having more sexual partners is associated with greater risk tolerance amongst men and greater impatience amongst women. Results highlight heterogeneity in the association between preferences and risky sexual behaviour.
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Affiliation(s)
- Ranjeeta Thomas
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom.
| | - Matteo M Galizzi
- Department of Psychology and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
| | - Louisa Moorhouse
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
| | - Constance Nyamukapa
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Timothy B Hallett
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
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Hermanns B, Kokot J. Contextual framing effects on risk aversion assessed using the bomb risk elicitation task. ECONOMICS LETTERS 2023:111227. [PMID: 37362549 PMCID: PMC10281696 DOI: 10.1016/j.econlet.2023.111227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
We examine the impact of framing on individuals' risk-taking behavior in the context of health risks during the coronavirus outbreak. We elicit risk attitudes from a sample of 3,385 individuals across seven European countries using an incentivized decision-making task. Participants are randomly assigned to one of three versions of the task: one involving the risk of a bomb explosion, one involving the risk of contracting an infectious disease, and one involving opening an empty box. We find that the framing of the task significantly affects risk-taking behavior, with participants exhibiting greater risk aversion in the health task than in the bomb or neutral task. This framing effect is observed in the majority of the countries studied.
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Affiliation(s)
- Benedicta Hermanns
- University of Hamburg, Mittelweg 177, Hamburg, 20148, Germany
- Hamburg Center for Health Economics, Esplanade 36, Hamburg, 20354, Germany
| | - Johanna Kokot
- University of Hamburg, Mittelweg 177, Hamburg, 20148, Germany
- Hamburg Center for Health Economics, Esplanade 36, Hamburg, 20354, Germany
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7
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Attema AE, L'Haridon O, van de Kuilen G. Decomposing social risk preferences for health and wealth. JOURNAL OF HEALTH ECONOMICS 2023; 90:102757. [PMID: 37062256 DOI: 10.1016/j.jhealeco.2023.102757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 06/19/2023]
Abstract
This study reports the results of the first artefactual field experiment designed to measure the prevalence of aversion toward different components of social risks in a large and demographically representative sample. We identify social risk preferences for health and wealth for losses and gains, and decompose these attitudes into four different dimensions: individual risk, collective risk, ex-post inequality, and ex-ante inequality. The results of a non-parametric analysis suggest that aversion to risk and inequality is the mean preference for outcomes in health and wealth in the domain of gains and losses. A parametric decomposition of aversion to risk and inequality shows that respondents are averse to ex-post and ex-ante inequality in health and wealth for gains and losses. Likewise, respondents are averse to collective risk, but neutral to individual risk, which highlights the importance of considering different components of social risk preferences when managing social health and wealth risks.
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Affiliation(s)
- Arthur E Attema
- EsCHER, Erasmus School of Health Policy & Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, Netherlands.
| | - Olivier L'Haridon
- CREM, Université de Rennes 1, Rennes, France, and Ghent University, Ghent, Belgium
| | - Gijs van de Kuilen
- Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands
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8
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Björkman Nyqvist M, Corno L, de Walque D, Svensson J. HIV, risk, and time preferences: Evidence from a general population sample in Lesotho. HEALTH ECONOMICS 2022; 31:904-911. [PMID: 35150024 DOI: 10.1002/hec.4476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
Identifying individuals most at risk of HIV infection is a priority for policymakers. Apart from specific groups, however, little is known about how to identify those at high risk in the population. Research suggests that attitudes toward risk and time preferences may influence risky sexual behavior, but no studies have so far investigated the interplay between risk attitudes, time preference, and HIV infection. We collect data on risk and time preferences using hypothetical games (multiple price list method) at baseline and data on HIV status at baseline (2010) and endline (2012) allowing us to calculate incidence rate over a 2-year period among 675 participants, males and females 18-32 years old in Lesotho. We find robust evidence of a statistically significant positive associations between HIV incidence and prevalence and risk-loving attitudes, while the associations with risky behaviors and time preferences are not statistically significant. A measure of attitude toward risk, relatively easy to administer to individuals in a survey, is thus associated with future HIV status. This is an important finding for policymakers and suggests the importance of targeting HIV prevention programs to risk-loving individuals and therefore improving program efficiency.
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Affiliation(s)
| | - Lucia Corno
- Universita' Cattolica del Sacro Cuore and LEAP, Milano, Italy
| | - Damien de Walque
- Development Research Group, World Bank Group, Washington, DC, USA
| | - Jakob Svensson
- Institute for International Economic Studies, Stockholm University, Stockholm, Sweden
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9
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Stolk-Vos AC, Attema AE, Manzulli M, van de Klundert JJ. Do patients and other stakeholders value health service quality equally? A prospect theory based choice experiment in cataract care. Soc Sci Med 2022; 294:114730. [DOI: 10.1016/j.socscimed.2022.114730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/23/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
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10
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Gandjour A. Financial Incentives in the Path to Recovery from the COVID-19 Pandemic. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:5-8. [PMID: 34719753 PMCID: PMC8557961 DOI: 10.1007/s40258-021-00689-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Adickesallee 32-34, 60322, Frankfurt am Main, Germany.
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11
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Weyant C, Brandeau ML. Partial Personalization of Medical Treatment Decisions: Adverse Effects and Possible Solutions. Med Decis Making 2022; 42:8-16. [PMID: 34027738 PMCID: PMC8606611 DOI: 10.1177/0272989x211013773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Personalizing medical treatment decisions based on patient-specific risks and/or preferences can improve health outcomes. Decision makers frequently select treatments based on partial personalization (e.g., personalization based on risks but not preferences or vice versa) due to a lack of data about patient-specific risks and preferences. However, partially personalizing treatment decisions based on a subset of patient risks and/or preferences can result in worse population-level health outcomes than no personalization and can increase the variance of population-level health outcomes. METHODS We develop a new method for partially personalizing treatment decisions that avoids these problems. Using a case study of antipsychotic treatment for schizophrenia, as well as 4 additional illustrative examples, we demonstrate the adverse effects and our method for avoiding them. RESULTS For the schizophrenia treatment case study, using a previously proposed modeling approach for personalizing treatment decisions and using only a subset of patient preferences regarding treatment efficacy and side effects, mean population-level health outcomes decreased by 0.04 quality-adjusted life-years (QALYs; 95% credible interval [crI]: 0.02-0.06) per patient compared with no personalization. Using our new method and considering the same subset of patient preferences, mean population-level health outcomes increased by 0.01 QALYs (95% crI: 0.00-0.03) per patient as compared with no personalization, and the variance decreased. LIMITATIONS We assumed a linear and additive utility function. CONCLUSIONS Selecting personalized treatments for patients should be done in a way that does not decrease expected population-level health outcomes and does not increase their variance, thereby resulting in worse risk-adjusted, population-level health outcomes compared with treatment selection with no personalization. Our method can be used to ensure this, thereby helping patients realize the benefits of treatment personalization without the potential harms.
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Affiliation(s)
- Christopher Weyant
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA
| | - Margaret L. Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA
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12
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Fernandez KA, Hamilton RH, Cabrera LY, Medaglia JD. Context-Dependent Risk & Benefit Sensitivity Mediate Judgments About Cognitive Enhancement. AJOB Neurosci 2022; 13:73-77. [PMID: 34931943 PMCID: PMC9867800 DOI: 10.1080/21507740.2021.2001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Opinions about cognitive enhancement (CE) are context-dependent. Prior research has demonstrated that factors like peer pressure, the influence of authority figures, competition, moral relevance, familiarity with enhancement devices, expertise, and the domain of CE to be enhanced can influence opinions. The variability and malleability of patient, expert, and public attitudes toward CE is important to describe and predict because these attitudes can influence at-home, clinical, research, and regulatory decisions. If individual preferences vary, they could influence opinions about practices and regulations due to disagreements about the desirable levels of risks and benefits. The study of attitudes about CE would benefit from psychological theories that explain judgments. In particular, we suggest that variability in risk and benefit sensitivity could psychologically mediate judgments about CE in many contexts. Drawing from prospect theory, which originated in behavioral economics, it is likely that framing effects, shifted reference points, and the tendency to weigh losses (risks) more heavily than gains (benefits) predict decisions about CE. We suggest that public policy could benefit from a shared conceptual framework, such as prospect theory, that allows us to describe and predict real-world decisions about CE by patients, experts, and the public.
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Affiliation(s)
| | | | | | - John D. Medaglia
- Drexel University and Perelman School of Medicine, University of Pennsylvania
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Zhu J, Li X, Chu H, Li J. Willingness to use community health centres for initial diagnosis: the role of policy incentives among Chinese patients. Aust J Prim Health 2021; 28:49-55. [PMID: 34903328 DOI: 10.1071/py21028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
Abstract
The aim of the study is to investigate the effect of policy incentives on residents' willingness to use community health centres for initial diagnosis. A cross-sectional survey with specific multiple price-list experiments was conducted in Guizhou, China. We were able to use in-depth individual interviews with a total of 422 participants. Our results showed that both financial and non-financial policy incentives can facilitate the utilisation of the community health centres. Approximately 60% of the respondents reported an increase in their willingness to use community health centres after the presentation of the financial policy, whereas 50% of respondents expressed an increase in their willingness to use community health centres with the non-financial policy. However, to some specific subgroups, such as residents with low trust, residents without chronic disease, residents with less healthcare visits and risk-averters, the impact of policy incentives were limited. The policy incentives are useful tools to attract more visitors to community health centres for initial diagnosis; however, their incentive effects vary in different subgroups. Thus, to change patients' perceptions regarding healthcare provider choice for initial diagnosis, policymakers should consider the heterogeneous responses of patients to policy incentives and focus their efforts on key cohorts.
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Affiliation(s)
- Jingrong Zhu
- School of Economics and Management, Communication University of China, Beijing 100024, China; and Corresponding author
| | - Xiaofei Li
- College of Business, Capital University of Economics and Business, Beijing 100070, China
| | - Hongrui Chu
- School of Management and Engineering, Capital University of Economics and Business, Beijing 100070, China
| | - Jinlin Li
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
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Guenther B, Galizzi MM, Sanders JG. Heterogeneity in Risk-Taking During the COVID-19 Pandemic: Evidence From the UK Lockdown. Front Psychol 2021; 12:643653. [PMID: 33868115 PMCID: PMC8046913 DOI: 10.3389/fpsyg.2021.643653] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
In two pre-registered online studies during the COVID-19 pandemic and the early 2020 lockdown (one of which with a UK representative sample) we elicit risk-tolerance for 1,254 UK residents using four of the most widely applied risk-taking tasks in behavioral economics and psychology. Specifically, participants completed the incentive-compatible Balloon Analog Risk Task (BART) and the Binswanger-Eckel-Grossman (BEG) multiple lotteries task, as well as the Domain-Specific Risk-Taking Task (DOSPERT) and the self-reported questions for risk-taking used in the German Socio-economic Panel (SOEP) study. In addition, participants in the UK representative sample answered a range of questions about COVID-19-related risky behaviors selected from the UCL COVID-19 Social Survey and the ICL-YouGov survey on COVID-19 behaviors. Consistently with pre-COVID-19 times, we find that risk tolerance during the UK lockdown (i) was higher in men than in women and (ii) decreased with age. Undocumented in pre-COVID-19 times, we find some evidence for healthier participants displaying significantly higher risk-tolerance for self-reported risk measures. We find no systematic nor robust patterns of association between the COVID-19 risky behaviors and the four risk-taking tasks in our study. Moreover, we find no evidence in support of the so-called "risk compensation" hypothesis. If anything, it appears that participants who took greater risk in real-life COVID-19-relevant risky behaviors (e.g., isolating or taking precautions) also exhibited higher risk-tolerance in our experimental and self-reported risk-taking measures.
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Affiliation(s)
- Benno Guenther
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
- Salient Behavioural Consultants Ltd., London, United Kingdom
| | - Matteo M. Galizzi
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
| | - Jet G. Sanders
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
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15
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Zhu J, Shi Y, Li J, Zhang Z. Role of risk attitude and time preference in preventive aspirin use adherence. J Eval Clin Pract 2020; 26:819-825. [PMID: 31478307 DOI: 10.1111/jep.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Poor adherence to medication that is taken chronically for the prevention of cardiovascular disease (CVD) continues to occur. Poor adherence is a primary barrier to treatment success and affects not only the patient but also the health care system. OBJECTIVE We aim to explore the impacts of risk attitudes and time preferences on the decisions of patients to begin and comply with aspirin therapy for CVD prevention. METHODS Three hundred fifty-seven patients who used low-dose aspirin for CVD prevention under the guidance of their doctors completed the survey. The risk attitudes and time preferences of the patients were elicited using a multiple price list experiment. Logistic regression models were used to examine the predictors of adherence to aspirin use. RESULTS Risk-seeking behaviours were significantly associated with both nonparticipation (P < .01) and lower compliance (P < .05) in patients. The coefficient for time preference was only significant at the 0.05 level for the decision to initiate aspirin use, which indicated that more impatient patients were less likely to begin with the use of aspirin. Forgetfulness in using aspirin on time and a lack of knowledge (as well as a lack of belief in the use of aspirin) could largely explain the poor adherence to aspirin therapy. CONCLUSIONS The identification of risk seekers and of those individuals who discount the future to a lesser degree may help providers to formulate tailored strategies to their patients, thus effectively enhancing their adherence to treatment.
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Affiliation(s)
- Jingrong Zhu
- School of Management and Economics, Beijing Institute of Technology, Beijing, China.,College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania
| | - Yunfeng Shi
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Jinlin Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Zengbo Zhang
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
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16
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Lépine A, Treibich C. Risk aversion and HIV/AIDS: Evidence from Senegalese female sex workers. Soc Sci Med 2020; 256:113020. [PMID: 32454226 PMCID: PMC7306163 DOI: 10.1016/j.socscimed.2020.113020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/11/2020] [Accepted: 04/23/2020] [Indexed: 12/03/2022]
Abstract
HIV/AIDS is the second cause of mortality globally and there are 5000 new infections each day. Globally, sex workers are 13 times more at risk of HIV than the general population and in Senegal they have an HIV prevalence 16.5 times greater. Therefore, it is urgent to encourage behaviour change, which requires a better understanding of the reasons why sex workers engage in risky behaviours. We provide new evidence of the role of risk preferences on sexual behaviours, health behaviours and health outcomes of 600 female sex workers in Senegal in July and August 2017. We measure risk aversion of sex workers using an incentivised Gneezy and Potters task in addition to specific risk-taking scales in four domains (in general, finance, health and sex). Understanding of the experimental task was high despite low literacy level of participants. Using ordinary least squares, we find that risk aversion is an important predictor of sex workers’ sexual behaviours. We find that sex workers with higher level of risk aversion have less sex acts with clients, have less clients at risk of HIV, are more likely to engage in protected sex acts and as a result earn less money per sex act. Furthermore, we find that sex workers exhibiting higher level of risk aversion are less likely to be infected with sexually transmitted infections. Results highlight that some associations between risk preferences and sexual and health behaviours are domain specific. To conclude, our results confirm the role of risk preferences in the spread of HIV/AIDS epidemic and suggest the importance of collecting information on self-reported risk aversion to identify individuals who are at a greater risk of HIV/AIDS. Finally, our results provide some rationale in using lottery-based financial incentives to prevent sexually transmitted infections and HIV/AIDS among high-risk populations. We study the role of risk preferences on HIV/AIDS among sex workers in Senegal. Risk preferences were elicited in a lab-in- the-field experiment and self-reported. Risk aversion is a main predictor of sexual behaviours. The relationship between risk aversion and behaviours is domain-specific.
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Affiliation(s)
- Aurélia Lépine
- University College London, Institute for Global Health, London, UK.
| | - Carole Treibich
- University Grenoble Alpes, CNRS, INRAE, Grenoble INP, GAEL, 38000, Grenoble, France
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Lipman SA, Attema AE. Rabin's paradox for health outcomes. HEALTH ECONOMICS 2019; 28:1064-1071. [PMID: 31218778 PMCID: PMC6771755 DOI: 10.1002/hec.3918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 06/09/2023]
Abstract
Many health economic studies assume expected utility maximisation, with typically a concave utility function to capture risk aversion. Given these assumptions, Rabin's paradox (RP) involves preferences over mixed gambles yielding moderate outcomes, where turning down such gambles imply absurd levels of risk aversion. Although RP is considered a classic critique of expected utility, no paper has as of yet fully tested its preferences within individuals. In an experiment we report a direct test of RP in the health domain, which was previously only considered in the economic literature, showing it may have pervasive implications here too. Our paper supports the shift towards alternative, empirically valid models, such as prospect theory, also in the health domain. These alternative models are able to accommodate Rabin's paradox by allowing reference-dependence and loss aversion.
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Affiliation(s)
- Stefan A. Lipman
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Arthur E. Attema
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
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Rodríguez-Míguez E, Pinto-Prades JL, Mosquera-Nogueira J. Eliciting Health State Utilities Using Paired-Gamble Methods: The Role of the Starting Point. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:446-452. [PMID: 30975396 DOI: 10.1016/j.jval.2019.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/19/2018] [Accepted: 01/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Paired-gamble methods have been proposed to avoid the "certainty effect" associated with standard gamble methods. OBJECTIVE This study examines the role of starting-point effects in paired-gamble methods. In particular, it examines how the utilities so derived vary as a function of the probabilities of the stimulus lottery. METHODS A sample of 455 members of the Spanish general population valued 9 health states via face-to-face interviews. Subjects were randomly placed into 3 subgroups, which differed in terms of the stimulus gamble's probability. Nonparametric tests and an interval regression model were used to test if utilities change when the probability distribution is modified. RESULTS Nonparametric tests showed that the probability of a health state being considered worse than death did not differ among subgroups. Nevertheless, changes in the stimulus gamble did produce significant differences in the distribution of utilities: the higher the probability of full health in the stimulus, the higher the utility elicited. Regression estimates support the existence of starting-point effects when the utilities are obtained under expected utility. According to the prospect theory, the conclusions depend on the reference point considered. When the reference points used are death or the health state evaluated, we observe differences among these groups. Nevertheless, when full health is used, these differences disappear. CONCLUSION This research suggests that paired-gamble methods may also be susceptible to starting-point effects. Yet the differences are small, and they disappear when the data are analyzed using prospect theory with full health as the reference point.
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Affiliation(s)
- Eva Rodríguez-Míguez
- Department of Applied Economics, Group of Research in Empirical Economics (GRiEE), ECOBAS, University of Vigo, Vigo, Spain; Fundación Biomédica Galicia Sur, Vigo, Spain.
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Mezzio DJ, Nguyen VB, Kiselica A, O'Day K. Evaluating the Presence of Cognitive Biases in Health Care Decision Making: A Survey of U.S. Formulary Decision Makers. J Manag Care Spec Pharm 2018; 24:1173-1183. [PMID: 30362919 PMCID: PMC10397589 DOI: 10.18553/jmcp.2018.24.11.1173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Behavioral economics is a field of economics that draws on insights from psychology to understand and identify patterns of decision making. Cognitive biases are psychological tendencies to process information in predictable patterns that result in deviations from rational decision making. Previous research has not evaluated the influence of cognitive biases on decision making in a managed care setting. OBJECTIVE To assess the presence of cognitive biases in formulary decision making. METHODS An online survey was conducted with a panel of U.S. pharmacy and medical directors who worked at managed care organizations and served on pharmacy and therapeutics committees. Survey questions assessed 4 cognitive biases: relative versus absolute framing effect, risk aversion, zero-risk bias, and delay discounting. Simulated data were presented in various scenarios related to adverse event profiles, drug safety and efficacy, and drug pricing for new hypothetical oncology products. Survey questions prompted participants to select a preferred drug based on the information provided. Survey answers were analyzed to identify decision patterns that could be explained by the cognitive biases. Likelihood of bias was analyzed via chi-square tests for framing effect, risk aversion, and zero-risk bias. The delay discounting section used a published algorithm to characterize discounting patterns. RESULTS A total of 35 pharmacy directors and 19 medical directors completed the survey. In the framing effect section, 80% of participants selected the suboptimal choice in the relative risk frame, compared with 38.9% in the absolute risk frame (P < 0.0001). When assessing risk aversion, 42.6% and 61.1% of participants displayed risk aversion in the cost- and efficacy-based scenarios, respectively, but these were not statistically significant (P = 0.27 and P = 0.10, respectively). In the zero-risk bias section, results from each scenario diverged. In the first zero-risk bias scenario, 90.7% of participants selected the drug with zero risk (P < 0.001), but in the second scenario, only 32.1% chose the zero-risk option (P < 0.01). In the section assessing delay discounting, 54% of survey participants favored a larger delayed rebate over a smaller immediate discount. A shallow delay discounting curve was produced, which indicated participants discounted delayed rewards to a minimal degree. CONCLUSIONS Pharmacy and medical directors, like other decision makers, appear to be susceptible to some cognitive biases. Directors demonstrated a tendency to underestimate risks when they were presented in relative risk terms but made more accurate appraisals when information was presented in absolute risk terms. Delay discounting also may be applicable to directors when choosing immediate discounts over delayed rebates. However, directors neither displayed a statistically significant bias for risk aversion when assessing scenarios related to drug pricing or clinical efficacy nor were there significant conclusions for zero-risk biases. Further research with larger samples using real-world health care decisions is necessary to validate these findings. DISCLOSURES This research was funded by Xcenda. Mezzio, Nguyen, and O'Day are employees of Xcenda. Kiselica was employed by Xcenda at the time the study was conducted. The authors have nothing to disclose. A portion of the preliminary data was presented as posters at the 2017 AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 27-30, 2017; in Denver, CO, and the 2017 International Society for Pharmacoeconomics and Outcomes Research 22nd Annual International Meeting; May 20-24, 2017; in Boston, MA.
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Fredslund EK, Mørkbak MR, Gyrd-Hansen D. Different domains – Different time preferences? Soc Sci Med 2018; 207:97-105. [DOI: 10.1016/j.socscimed.2018.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/18/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
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Martín-Fernández J, Medina-Palomino HJ, Ariza-Cardiel G, Polentinos-Castro E, Rutkowski A. Health condition and risk attitude in the Dutch population: an exploratory approach. HEALTH, RISK & SOCIETY 2018. [DOI: 10.1080/13698575.2018.1458976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jesús Martín-Fernández
- Villamanta Clinic (Navalcarnero Health Centre), Primary Healthcare Management, Madrid Health Service, Madrid, Spain
- Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
- Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
| | | | - Gloria Ariza-Cardiel
- Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Multiprofessional Teaching Unit of Primary and Community Care, Primary Healthcare Management, Madrid Health Service, Madrid, Spain
| | - Elena Polentinos-Castro
- Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Multiprofessional Teaching Unit of Primary and Community Care, Primary Healthcare Management, Madrid Health Service, Madrid, Spain
| | - Anne Rutkowski
- Department of Management, Tilburg University, Tilburg, The Netherlands
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Jelovac I, Polomé P. Incentives to patients versus incentives to health care providers: The users' perspective. HEALTH ECONOMICS 2017; 26:e319-e331. [PMID: 28497483 DOI: 10.1002/hec.3511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 10/13/2016] [Accepted: 02/15/2017] [Indexed: 06/07/2023]
Abstract
In theory, health care providers may adapt their professional behavior to the financial incentives resulting from their remuneration. Our research question is whether the users of health care services anticipate such behavior from their general practitioner (GP) and, if they do, what consequences such anticipation has on their preferences regarding financial incentives. Our theoretical model explains users' preferences for one or another incentives scheme, disentangling the financial motives (incentives amounts, wealth) from the behavioral ones (perceived GPs' sensitivity to incentives). We empirically test our theoretical predictions using data from a survey that elicits individual preferences for either patient or provider hypothetical incentives in France. The empirical results confirm the theoretical ones: users tend to prefer incentives to patients rather than to GPs when the amount of GP incentives is high, when the amount of patient incentives is low, when they anticipate that their GP's medical decisions are affected by financial incentives or when their wealth is high. Otherwise, they prefer their GP to face financial incentives.
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Affiliation(s)
- Izabela Jelovac
- University of Lyon, Lyon, France
- CNRS, GATE Lyon Saint-Etienne, Ecully, France
| | - Philippe Polomé
- University of Lyon, Lyon, France
- CNRS, GATE Lyon Saint-Etienne, Ecully, France
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Arrieta A, García-Prado A, González P, Pinto-Prades JL. Risk attitudes in medical decisions for others: An experimental approach. HEALTH ECONOMICS 2017; 26 Suppl 3:97-113. [PMID: 29285873 DOI: 10.1002/hec.3628] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
The aim of this paper is to investigate how risk attitudes in medical decisions for others vary across health contexts. A lab experiment was designed to elicit the risk attitudes of 257 medical and nonmedical students by assigning them the role of a physician who must decide between treatments for patients. An interval regression model was used to estimate individual coefficients of relative risk aversion, and an estimation model was used to test for the effect of type of medical decision and experimental design characteristics on elicited risk aversion. We find that (a) risk attitudes vary across different health contexts, but risk aversion prevails in all of them; (b) students enrolled in health-related degrees show a higher degree of risk aversion; and (c) real rewards for third parties (patients) make subjects less risk-averse. The results underline the importance of accounting for attitudes towards risk in medical decision making.
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Mørkbak MR, Gyrd-Hansen D, Kjær T. Can present biasedness explain early onset of diabetes and subsequent disease progression? Exploring causal inference by linking survey and register data. Soc Sci Med 2017; 186:34-42. [DOI: 10.1016/j.socscimed.2017.05.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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Goldzahl L. Contributions of risk preference, time orientation and perceptions to breast cancer screening regularity. Soc Sci Med 2017; 185:147-157. [DOI: 10.1016/j.socscimed.2017.04.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 04/12/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Galizzi MM, Miraldo M, Stavropoulou C, van der Pol M. Doctor-patient differences in risk and time preferences: A field experiment. JOURNAL OF HEALTH ECONOMICS 2016; 50:171-182. [PMID: 27792903 DOI: 10.1016/j.jhealeco.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 06/06/2023]
Abstract
We conduct a framed field experiment among patients and doctors to test whether the two groups have similar risk and time preferences. We elicit risk and time preferences using multiple price list tests and their adaptations to the healthcare context. Risk and time preferences are compared in terms of switching points in the tests and the structurally estimated behavioural parameters. We find that doctors and patients significantly differ in their time preferences: doctors discount future outcomes less heavily than patients. We find no evidence that doctors and patients systematically differ in their risk preferences in the healthcare domain.
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Affiliation(s)
- Matteo M Galizzi
- Department of Social Policy, Behavioural Research Lab, LSE Health, London School of Economics, Old 2.35 Old Building, Houghton Street, London WC2A 2AE, UK; École d'Économie de Paris, Hospinnomics, Paris School of Economics, Hôtel-Dieu, 1, Parvis de Notre-Dame, Bâtiment B1, 5° étage, 75004 Paris, France.
| | - Marisa Miraldo
- École d'Économie de Paris, Hospinnomics, Paris School of Economics, Hôtel-Dieu, 1, Parvis de Notre-Dame, Bâtiment B1, 5° étage, 75004 Paris, France; Management Group, Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK.
| | - Charitini Stavropoulou
- School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
| | - Marjon van der Pol
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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