Paying For Testing In Advance Encourages Preventive Care
A health care plan in which members pay in advance for preventive tests may be more effective in encouraging positive behavior than standard health care plans or plans that pay the insured for attending screenings, according to researchers Dan Ariely and Janet Schwartz of Princeton University’s Institute for Advanced Studies.
In an online survey conducted by Survey Sampling International (SSI), 1,000 participants were randomly assigned to two groups. Half were asked to review a “prepay” plan, in which the insured pays a monthly fee of $85, but also prepays the co-pays for routine tests and screenings. For example, the insured might prepay $15 for a routine physical, $25 for routine blood and urinalysis tests, $15 for a mammogram, and $10 for life-saving or life-extending medications. Under the prepay plan, participants are reimbursed if they go to their scheduled appointments but forfeit the prepayments if they miss the appointments.
The second group was asked to consider a “payback” plan, in which the insured pays a monthly fee of $125 and the insurance company pays the insured to take important health tests and screenings. The insurance provider may, for example, pay the insured $50 for attending a routine physical, $50 for taking routine blood and urinalysis test, $100 for attending a mammogram screening, and $10 per medication for filling prescriptions for life-saving or life-extending drugs.
Both groups were asked to compare the attractiveness of the plans with that of a standard insurance plan, under which the insured pays a monthly fee of $85, as well as co-pays for tests, screenings, prescriptions, and doctors’ visits.
Among the study’s objectives, Ariely explained, was to find out whether people would be willing to sacrifice money to gain control over their lives. “Would they be willing to pre-pay $250 for a colonoscopy and get the money back if they show up on time for the procedure? They are risking losing the money by pre-paying. We wondered if pre-paying could motivate people to get the preventive care.”
Results of the survey showed that, of those who were offered the choice of a standard plan or a payback plan, 58% preferred the standard plan and 42% preferred the payback plan. But, of those who were asked to choose between a standard plan or a prepay plan, 56% selected the prepay plan, while 44% preferred the standard plan.
Commenting on the survey results, Schwartz said, “This suggests to us that people like the element of self-control. Payback is nice and reduces some of the negative emotion produced by having to pay for things that are unpleasant, but it’s not really enough to make the plan more attractive than the standard plan.”
By contrast, Schwartz noted, “pre-payment confronts two issues: one, that people shouldn’t have to add the ‘pain’ of financial loss to the discomfort of having tests; and two, that the prepay plan addresses the issue of self-control. ‘If I don’t go for my mammogram, I lose $50.’”
The finding that people tend to prefer the prepay plan to the payback plan, Schwartz said, “suggests that people are more attracted to plans that will motivate behavioral change and self-control than to pure economic incentives to engage in routine preventive care.”
