Doctoral Dissertation in DRMS: Choice Sets and Consumer Selection of Health Plans

这个项目研究消费者对越来越多的有价值的商品和服务的选择的反应。传统的经济理论预测，更多的选择增加了消费者找到并选择符合他们偏好的产品的可能性。然而，有关有限理性的文献却给出了相反的结论。涉及低成本消费品的研究表明，随着选择数量的增加，消费者表现出更大的倾向：a)拒绝做出选择（“选择延迟”），尽管他们在更有限的集合中有选择，b)在决策中犯错误（“选择病态”）。尽管这些最近的研究具有启发性，但仍有一些重要的问题没有得到解答。对于高风险的选择，选择延迟和相关的病理是否明显？这些影响的大小与选择的数量有何关系？有限理性是否反映了消费者的认知能力已经被超越，或者仅仅反映了消费者对其偏好的不确定性？这个项目解决了这些问题，适用于健康保险计划的当代选择。这些问题的答案与当代美国的医疗改革息息相关。增加消费者的选择是最近政策变化的标志，从医疗现代化法案到私营部门消费者导向的健康计划。如果医疗保险受益人希望参加医疗保险C部分的管理式医疗计划，他们现在（取决于他们的居住地）有10种以上的选择，而作为医疗保险D部分的一部分，他们有50种以上的处方药计划。关于消费者对医疗保险C和D的困惑的轶事报道，加上对医疗保险D部分福利的低接受率，证明了认知限制的潜在相关性。使用混合方法，我们测试了较大的选择集是否与以下因素相关：(1)消费者推迟健康计划的选择，放弃在较小的选择集中选择的选项，(2)消费者未能从表现不佳的计划中退出（使他们易受伤害并屏蔽市场信号），以及(3)选择计划的消费者在选择计划时犯更多错误。我们将使用实验技术来确定选择延迟和相关病理是否存在于健康计划中，并探讨它们存在的原因。然后，我们分析调查数据，以确定这些影响在涉及健康计划的现实选择中的普遍性和程度。

This project studies consumers' response to an increasing number of options among valued goods and services. Conventional economic theory predicts that more options increase the probability of consumers finding and choosing a product that well matches their preferences. The literature on bounded rationality, however, suggests otherwise. Research involving low-cost consumer goods documents that as the number of options increase, consumers show a greater propensity to a) refuse to make a choice ("choice deferral"), despite having options they would have selected in more restricted sets, and b) make errors in their decision making ("choice pathologies"). Although suggestive, these recent studies leave important questions unanswered. Are choice deferral and associated pathologies evident for high-stakes choices? How is the magnitude of these effects related to the number of choices? Does bounded rationality reflect that consumers' cognitive capacities have been exceeded or simply reflect consumers' uncertainty about their preferences? This project addresses these questions, applied to contemporary choices among health insurance plans.The answers are relevant to contemporary health care reform in the United States. Increasing consumer choice is the hallmark of recent policy changes, ranging from the Medicare Modernization Act to consumer-directed health plans in the private sector. Medicare beneficiaries now have (depending on their place of residence) upwards of 10 options if they wish to enroll in a managed care plan under Medicare Part C and upwards of 50 prescription drug plans as part of Medicare Part D. Anecdotal reports of consumer confusion about Medicare C and D, combined with low take-up rates for Part D benefits, demonstrate the potential relevance of cognitive constraints. Using mixed methods, we test whether larger choice sets are associated with (1) consumers deferring choice of health plans, foregoing options that would have been selected in a smaller choice set, (2) consumers failing to disenroll from poorly performing plans (leaving them vulnerable and muting market signals), and (3) consumers who do choose making more errors in selecting among plans. We will use experimental techniques to identity whether choice deferral and associated pathologies exist for health plans and explore why they exist. We then analyze survey data to identify the prevalence and magnitude of these effects in real-world choices involving health plans.