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Suit the action to the word, the word to the action: Hypothetical choices and real decisions in Medicare Part D

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  • Kesternich, Iris
  • Heiss, Florian
  • McFadden, Daniel
  • Winter, Joachim

Abstract

In recent years, consumer choice has become an important element of public policy. One reason is that consumers differ in their tastes and needs, which they can express most easily through their own choices. Elements that strengthen consumer choice feature prominently in the design of public insurance markets, for instance in the United States in the recent introduction of prescription drug coverage for older individuals via Medicare Part D. For policy makers who design such a market, an important practical question in the design phase of such a new program is how to deduce enrollment and plan selection preferences prior to its introduction. In this paper, we investigate whether hypothetical choice experiments can serve as a tool in this process. We combine data from hypothetical and real plan choices, elicited around the time of the introduction of Medicare Part D. We first analyze how well the hypothetical choice data predict willingness to pay and market shares at the aggregate level. We then analyze predictions at the individual level, in particular how insurance demand varies with observable characteristics. We also explore whether the extent of adverse selection can be predicted using hypothetical choice data alone.

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  • Kesternich, Iris & Heiss, Florian & McFadden, Daniel & Winter, Joachim, 2013. "Suit the action to the word, the word to the action: Hypothetical choices and real decisions in Medicare Part D," Journal of Health Economics, Elsevier, vol. 32(6), pages 1313-1324.
  • Handle: RePEc:eee:jhecon:v:32:y:2013:i:6:p:1313-1324
    DOI: 10.1016/j.jhealeco.2012.11.006
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    5. Determann, Domino & Lambooij, Mattijs S. & de Bekker-Grob, Esther W. & Hayen, Arthur P. & Varkevisser, Marco & Schut, Frederik T. & Wit, G. Ardine de, 2016. "What health plans do people prefer? The trade-off between premium and provider choice," Social Science & Medicine, Elsevier, vol. 165(C), pages 10-18.
    6. Kesternich, Iris & Heiss, Florian & McFadden, Daniel & Winter, Joachim, 2013. "Suit the action to the word, the word to the action: Hypothetical choices and real decisions in Medicare Part D," Journal of Health Economics, Elsevier, vol. 32(6), pages 1313-1324.
    7. de Bekker-Grob, E.W. & Donkers, B. & Bliemer, M.C.J. & Veldwijk, J. & Swait, J.D., 2020. "Can healthcare choice be predicted using stated preference data?," Social Science & Medicine, Elsevier, vol. 246(C).
    8. Matthew Shapiro & Joseph Briggs & Chris Tonetti & Andrew Caplin & John Ameriks, 2016. "Late-in-Life Risks and the Under-Insurance Puzzle," 2016 Meeting Papers 241, Society for Economic Dynamics.
    9. Francesco Decarolis & Maria Polyakova & Stephen P. Ryan, 2020. "Subsidy Design in Privately Provided Social Insurance: Lessons from Medicare Part D," Journal of Political Economy, University of Chicago Press, vol. 128(5), pages 1712-1752.
    10. Mark Dickie & Shelby Gerking & Wiktor Adamowicz & Marcella Veronesi, 2020. "Risk Perception, Learning and Willingness to Pay to Reduce Heart Disease Risks," Working Papers 11/2020, University of Verona, Department of Economics.
    11. Milad Haghani & Michiel C. J. Bliemer & John M. Rose & Harmen Oppewal & Emily Lancsar, 2021. "Hypothetical bias in stated choice experiments: Part I. Integrative synthesis of empirical evidence and conceptualisation of external validity," Papers 2102.02940, arXiv.org.
    12. Soetevent, Adriaan R. & Bruzikas, Tadas, 2016. "Risk and Loss Aversion, Price Uncertainty and the Implications for Consumer Search," Research Report 16015-EEF, University of Groningen, Research Institute SOM (Systems, Organisations and Management).
    13. Esther W de Bekker-Grob & Arnold D Bergstra & Michiel C J Bliemer & Inge J M Trijssenaar-Buhre & Alex Burdorf, 2015. "Protective Behaviour of Citizens to Transport Accidents Involving Hazardous Materials: A Discrete Choice Experiment Applied to Populated Areas nearby Waterways," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-14, November.
    14. Chandoevwit, Worawan & Wasi, Nada, 2020. "Incorporating discrete choice experiments into policy decisions: Case of designing public long-term care insurance," Social Science & Medicine, Elsevier, vol. 258(C).
    15. Ericson, Keith Marzilli & Kessler, Judd B., 2016. "The articulation of government policy: Health insurance mandates versus taxes," Journal of Economic Behavior & Organization, Elsevier, vol. 124(C), pages 43-54.
    16. Tamara L. Sheldon & J. R. DeShazo & Richard T. Carson, 2017. "Electric And Plug-In Hybrid Vehicle Demand: Lessons For An Emerging Market," Economic Inquiry, Western Economic Association International, vol. 55(2), pages 695-713, April.
    17. Emily Lancsar & Joffre Swait, 2014. "Reconceptualising the External Validity of Discrete Choice Experiments," PharmacoEconomics, Springer, vol. 32(10), pages 951-965, October.
    18. Donald S. Kenkel & Sida Peng & Michael F. Pesko & Hua Wang, 2020. "Mostly harmless regulation? Electronic cigarettes, public policy, and consumer welfare," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1364-1377, November.
    19. Johannes G. Jaspersen, 2016. "Hypothetical Surveys And Experimental Studies Of Insurance Demand: A Review," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 83(1), pages 217-255, January.
    20. Nathan Kettlewell, 2020. "Policy Choice and Product Bundling in a Complicated Health Insurance Market: Do People Get It Right?," Journal of Human Resources, University of Wisconsin Press, vol. 55(2), pages 566-610.
    21. Fern Terris‐Prestholt & Matthew Quaife & Peter Vickerman, 2016. "Parameterising User Uptake in Economic Evaluations: The role of discrete choice experiments," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 116-123, February.
    22. John Ameriks & Joseph Briggs & Andrew Caplin & Matthew D. Shapiro & Christopher Tonetti, 2016. "The Long-Term-Care Insurance Puzzle: Modeling and Measurement," NBER Working Papers 22726, National Bureau of Economic Research, Inc.
    23. Jesús Clemente López & Pedro García Castrillo & María A. González Alvarez & Marcos Sanso Frago, 2014. "Una evaluación de la efectividad de la formación ocupacional para desempleados antes y después de la crisis económica: el caso de Aragón," Hacienda Pública Española / Review of Public Economics, IEF, vol. 208(1), pages 77-106, March.

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    More about this item

    Keywords

    Medicare; Health insurance demand; Hypothetical choice experiments;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • C25 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions; Probabilities
    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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