Anna Sinaiko*

Anna Sinaiko*

Assistant Professor of Health Economics and Policy, Harvard T.H. Chan School of Public Health
*Harvard PhD Program in Health Policy Alumna & Faculty Member

Dissertation Title:  "Essays on Consumer Behavior in Health Care"

Consumer use of information and whether consumers make decisions that are in their own best interest have important implications for the quality and efficiency of the health care system. This dissertation consists of three essays that seek to improve our understanding of consumer-decision making in health care settings.

The first essay (with Meredith Rosenthal) considers consumer experience with tiered physician networks. Tiered physician networks use financial incentives and quality information to encourage consumers to seek care from “preferred” physicians. We developed a survey to assess consumer’s awareness, use and trust of these networks included in health plans offered by the Massachusetts Group Insurance Commission (GIC). Half of respondents reported prior knowledge of the tiered networks and one-fifth knew which tier one of their doctors is in. Respondents who learned their doctor’s tier before their first visit were more likely to find this information important. The paper concludes with a discussion of the potential for these networks to influence consumer behavior and the cost-efficiency and quality of health care.

The second essay (with Richard Hirth) analyzes the health plan choices made by employees at a University when the set of health plans offered by their employer includes a dominated plan -- a plan that is the same or worse than another available plan on all dimensions and worse than that plan on at least one dimension for all possible health states. During the study period, approximately one-third of workers were enrolled in the dominated plan. For some this choice may be explained by inertia, i.e., individuals who may have selected the plan before it was dominated and then failed to switch out of it. However, a substantial number of employees selected the suboptimal plan when their initial choice set included both good and bad options. We observe differences in enrollment in the dominated plan and in decisions to switch out of it by gender. This evidence supports alternative economic models than that of the rational consumer, and suggests that health reform that relies heavily on consumer choice may result in unintended and inefficient outcomes.

The third essay returns to the context of tiered provider networks and analyzes how consumers might respond to tiered physician networks and whether consumer response is sensitive to the amount of differential cost-sharing across tiers and to the tiered doctor’s specialty. As part of a survey of GIC members who are enrolled in a health plan with a tiered physician network, we presented respondents with a hypothetical set of tiered networks that varied according to the co-payment required for physicians in the non-preferred tier ($!5/$25/$50) and the type of physician who was tiered (cardiologist/dermatologist). Respondents were less likely to say that they would choose to make an appointment with a Tier 1 doctor when they had a recommendation from another source for a Tier 2 doctor; individuals selecting a dermatologist and facing the largest co-payment difference across tiers were more likely to select a physician from the preferred tier (Tier 1). Among respondents who said they would choose a Tier 1 doctor, the doctor’s ranking is more important than the co-payment differential across the tiers. Simulation results suggest that the co-payment differential across tiers that is necessary to counteract the impact of a friend, family member or personal doctor’s recommendation for a Tier 2 physician is considerably larger than the current levels in the GIC health plans.


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