Consumer Decisionmaking in the Health Care Marketplace

Abstract

"June 28, 2016"--Table of contents page. "The Patient Protection and Affordable Care Act introduced the health insurance marketplaces, new online clearinghouses for buying and selling insurance. One of the benefits of the marketplaces is that they enable consumers to compare a variety of health insurance plans, and, ideally, select the plan that best suits their needs. However, the task of selecting a health insurance plan can be complicated because of such factors as difficulty understanding health insurance jargon, poor numeracy, inadequate decision-support tools, and an excessive number of choices. For this report, RAND researchers reviewed the literature on health insurance choice to understand how consumers make decisions and the extent to which confusion, lack of information, and other factors can hinder decisionmaking. They also reviewed literature on how to design websites to support consumers' choices and, where possible, gleaned best practices from the literature. They then reviewed 20 health insurance websites to understand the approaches these websites have taken to convey information to consumers. They found that existing health insurance websites follow some recommended practices, such as allowing consumers to sort and filter plans based on key characteristics. However, websites were lacking in other dimensions, such as in the use of out-of-pocket cost calculators, presentation of information on provider networks, and presentation of information about plan quality. Although, ideally, websites would convey such information to consumers, that might not be possible or desirable without better data. Future analyses should consider how alternative web design strategies affect actual choices among consumers enrolling in marketplace plans"--Publisher's description. Preface -- Figures -- Tables -- Summary -- Acknowledgments -- Abbreviations -- Chapter 1: Introduction -- Chapter 2: Literature Review: Background -- Methods -- Consumer Choice in the Context of Health Care: How Do Consumers Make Decisions? -- What Is the Appropriate Choice Architecture? Challenges to Effective Decisionmaking -- Previous Research on Health Insurance Website Design: Marketplace Regulations Affect Website Design and Choices -- Consumer Research Informed Website Design -- Health Insurance Choice Websites Sometimes Reflect Consumer Research Results -- Summary -- Approaches to Future Website Development from the Literature: Consumers Might Incorrectly Calculate Cost or Put Undue Emphasis on Premiums -- Choice Overload Might Lead to Suboptimal Decisions -- Consumers Might Have Difficulty Understanding Complex Health Insurance Information -- Consumers Might be Subject to Inertia or Status Quo Bias -- Limited Numeracy, Literacy, and Knowledge of Health Insurance Adversely Affect Individual Decisions -- Standardization of Products Might Promote Competition -- Is Nudging the Solution? -- Summary -- Chapter 3: Website Reviews: Introduction -- Methods: Framework Design -- Website Selection -- Website Review Process -- Limitations -- Findings: Many Pathways Exist to Navigate Sites -- Websites' Requirements for Personal Information Varied -- Plan Display -- Coverage Exemptions and Penalty Information -- Summary -- Chapter 4: Conclusion -- Appendix -- Bibliography.