Shafrin: People often perform better, in terms of choosing better when they have fewer choices. Why is that the case? Most economists think that more choice is better.
Hough: What behavioral psychologists and behavioral economists have discovered is that more choice is not necessarily better. The problem is regret bias. If they are shown five things and are asked to choose among them, they can probably choose well. But if they are offered 25 or 50, people end up not choosing at all. This is actually what happened at the beginning of Medicare Part D, when patients were given an extraordinary number of prescription drug plans choices, and a good number of the elderly were paralyzed by having to make that choice. My mother was an incredibly successful business woman, but when at the age of 85 she was faced with the choice of among 45 plans in Virginia for Part D, she just threw up her hands and said, “Well, I don't know which one to pick. Doug, you pick one for me.”
Shafrin: But who chooses the choices?
Hough: There are a couple of ways which I think would be bad. For instance, some expert sits down and decides, here are the 10 best choices. That expert might not have the right set of preferences (for) an individual. One of the ways of doing this is to offer an individual five different choices randomly chosen from the 45. If you don't like one, we can give you five more. Or if you like this one, we can give you a couple of others ones to compare it with. You can continue until you as an individual are satisfied that you have the right plan.
Shafrin: In France, they have the consumers pay for physician visits up front, and only later is the patient reimbursed by insurance. Would a similar system in the U.S. improve efficiency and reduce utilization?
Hough: I think it would be a great idea. Here's where you have a nice blend of standard economics and behavioral economics. Standard economics says that if you raise the price from effectively zero, which an insured individual is going to be paying, to an actual physical price, then they are going to think twice if they actually need to go to that physician. Here's where the behavioral economics comes in: Raising the price affects behavior even when they will be reimbursed for that payment within a short period of time. I think it would be very effective for controlling unnecessary utilization of healthcare services.
Jason Shafrin, who blogs at healthcare-economist.com, is a research economist at Precision Health Economics in Los Angeles.