Improving Incentives in Health Care Spending

Although U.S. economic growth is likely to continue to be robust, the growth of private and public spending on health care presents long-run public policy challenges. To meet these challenges health care resources must be used more efficiently. Currently, there are few incentives to put health care dollars to the highest value use. This is true in both public and private spending. An important element of the problem lies in the tax-preferred treatment given to employer-provided insurance but not to out-of-pocket spending. The resulting bias towards first-dollar insurance coverage means that consumers are insulated from the real costs of the health care that they consume and have little reason to evaluate whether the benefits are greater than those costs. Moreover, they seldom have sufficient price and quality information to make informed decisions. Health Savings Accounts (HSAs) are a promising way to remove the tax-penalty for enrolling in catastrophic insurance and paying for routine care out of pocket. Given the information that they need, consumers would then have more choices and more control, strengthening their role in reducing waste, improving efficiency, and promoting competition. Coupled with other policies, HSAs can be a critical component in moving toward an efficient and equitable health care system. JEL Classification I11     

Consumer use of the internet for health information: a survey of primary care patients

An increasing number of patients use the internet to obtain information about health. Although some information is available about how health professionals use the internet, little is known about how patients utilize this information. Some patients may actively seek information to assume more responsibility for their health. However, others may feel obliged to do so because of failing confidence in health care provision. Health professionals have the potential to assist patients to make sense of health information from the internet; however, they may not necessarily welcome this role. This study aims to evaluate patients’ use of such information in a primary care setting. The sample consisted of adult patients (n = 851) from two general practice populations at different levels of the socio‐economic spectrum in South Wales (UK). Patients were surveyed by questionnaire about the health information they use, including the internet. The majority of patients preferred to use their general practitioner as the main source of health information. The internet was jointly the second preferred source for information about an illness (6%). Just over half (51%) of patients in this study had access to the internet, of which about half use it to access health information. Just under a quarter (24%, n = 55) of health internet users had discussed information accessed from the internet during a subsequent consultation with a health professional. Of these, three‐quarters felt more prepared and able to participate in decision‐making about treatments. This study provides a greater understanding of how patients are making use of health‐related information from the internet. These findings can be used to help prepare health care professionals for dealing appropriately with internet‐informed patients.     

The effects of a plant closure on the stress levels and health of workers' wives — A preliminary analysis

In recent years an increasing amount of information leaves no doubt that the costs to the victims of plant closures are more than economic. The stress occasioned by job loss often results in ill health. These findings aside, little systematic research has been done of the consequences of unemployment for the spouses of the unemployed. In this article, a comparison is made between the effects of a closure on unemployed male employees and their wives. It is found that both groups suffer a high degree of anxiety over future job prospects and both experience a high level of stress as a result of the closure. However, for wives, anxiety, but not general stress, leads to ill health. For men, neither appears to have health implications: post-closure illness is related to illness prior to the shutdown. In one sense, two months after the closure, it can be argued that the impact of the shutdown was greater on wives than unemployed former employees.     

The algebra of health concerns: implications of consumer perception of health loss,illness and the breakdown of the health system on anxiety

The current and expected future state of the American health care system creates much concern and anxiety at the national and individual level among Americans. This study is in response to the call of the Institute of Medicine to further study the lack of confidence among Americans about their future ability to receive high‐quality health care. This study compares perceived anxiety and its amelioration as a result of three possible health situations: illness with infectious disease, losing one's health and a breakdown of the health care system. This empirical study was conducted within the framework of conjoint analysis. We conducted an experimental design of ideas, identified attributes that increased or reduced anxiety in each of the three health‐related situations and then segmented consumers on the basis of their patterns of reactions to the attributes. We found that the highest anxiety was attributed to the breakdown of the health care system. The segmentation further suggested that the anxiety emerging from the breakdown of society's health care system generated a different extent of anxiety than that which emerged from one's illness or one's loss of own health. The attributes that drove anxiety across the health situations were, surprisingly, charities, one's company, the local hospital and supplemental insurance. Attributes that reduced anxiety differed among segments. The attributes were found to be: close friends, family, distribution of information by authorities and the belief in God. At a practical level, these data and patterns of response allow health care policy makers to enhance the coping ability of patients by understanding the nature of what reduces the anxiety of individual types of patients. The approach in this study provides a person‐centred system for communication and anxiety reduction that can be implemented as part of a public health policy.     

Child–mother nutrition and health status in rural Kenya: the role of intra‐household resource allocation and education

There exists gender bias in resource ownership in many parts of Kenya with women being more disadvantaged. Resource ownership and control within the household has differential impacts on the health and overall well‐being of male and female members. This paper examines intra‐household resource ownership and how it affects nutrition and health status of household members. Data from a household survey containing detailed gender‐disaggregated information on resource ownership as well as food and anthropometry were collected from a rural Kenyan district and used in the analysis. Results showed that male members of the household had more access to education, income and land than the females. Mothers’ education, household income, frequency of illness and nutrient intake were the most important factors that contributed to the nutritional status of children. The education and household’s economic status were important determinants of child morbidity. Malnutrition and poor health of children and women is linked to the existing poverty in the study region, therefore emphasis needs to be put on eradication of discrimination against women in accessing education and accessing land, which will contribute to an increase in household incomes. Government policies need to focus on promotion of nutrition education through adult education programmes and incorporating it in the school curricula. Improvement of health‐care facilities in rural areas is also paramount to improving health and nutrition in these areas.     

How managers can lower mental illness costs by reducing stigma

The stigma associated with mental illness is not usually an issue that managers include in their portfolio of everyday concerns. However, published data from multiple sources makes it clear that the costs of doing business for any organization are increased when the very common conditions characterized as mental illnesses are stigmatized. Denial, fear of discovery, and insurance inadequacy among an organization's employees often delay treatment, harming organizational productivity and raising health care costs related to both the mental illness itself and other associated medical conditions. Additional costs to businesses range from the possibility of increased liability to higher taxes. To counter stigma among employees, the authors recommend personal communication with co-workers diagnosed with a mental illness, or with members of their families, to create new associations for these illnesses, which is a more effective approach than either education or anti-stigma messages. They also recommend communication to constituencies beyond one's own organization, joining with other companies to demonstrate actions aimed at community-wide stigma reduction, and offering consulting services to organizations promoting mental health.     

The impact of different types of concernment on the consumption of organic food

Previous research has mainly focused on consumers' environmental values and attitudes to explain green consumption. However, it has been neglected how situational factors like the way a consumer is affected by the impacts of environmental pollution influence environmental attitudes and the demand for organic food products. To fill this void, we firstly introduce a taxonomy of different types of factual concernment and perceived concern. Factual concernment describes the manner in which a person is affected by the negative consequences of environmental pollution, whereas perceived concern expresses an anxious sense of interest. Building on that taxonomy, an experimental study analyses how four types of factual concernment (direct vs. indirect; material vs. immaterial) influence consumers' perceived concerns (in terms of environmental and health concern) as well as the readiness to gather information, the readiness to make sacrifices, the willingness to pay higher prices and purchase intentions. The study reveals that particularly direct concernment fosters the consumption of organic food. However, the study did not find any differences between the influences of material and immaterial concernment on the organic food purchase decision.     

Antecedents and Consequences of Consumers' Response to Health Information Complexity

This study develops and empirically tests a model for understanding food consumers' health information seeking behaviour. Data were collected from 504 food consumers using a nationally representative consumer panel. The obtained Lisrel results suggest that consumers' product-specific health information seeking is positively affected by general food involvement and by usability of product-specific health information. Moreover, product-specific health information seeking and product-specific health information complexity are both positively related to post-purchase health-related dissonance. This link between information complexity and post-purchase dissonance has implications for marketers of food products since our results suggest that consumers might avoid purchasing the same food item again if post-purchase dissonance is experienced.     

The Effect of Delays in Information Exchange in Electronic Markets

In this research I explored the impact of information delays in a simple model of negotiation through an electronic market system. I found that a market can accurately reflect buyers' and sellers' preferences only if the rate of injection of price information multiplied by the rate of transfer of price information falls between 0 and 2. It is argued that markets adjust themselves to this constraint in practice. The alternatives are to experience chaotic and catastrophic volatility in prices or to go out of operation. Thus, electronic commerce can provide value beyond merely speeding up operations and increasing capacity. It also helps avoid misleading behavior by both buyer and seller and allows markets to operate in a wider range of trading environments.     

Consumer Attitudes and Food Faddism: The Case of Vitamin E

Attitudes toward vitamin E were studied in an effort to gain insight into the variables associated with consumption of fad food products. Vitamin E was chosen as a typical fad food product because nutrition researchers and government agencies have generally agreed that supplementation is unnecessary in the normal human diet. A survey of 252 students revealed a 15% incidence of vitamin E use. The backgrounds, attitudes and self-report personality inventories of the students did not support the view that use of such health products as vitamin E is necessarily associated with low socioeconomic status, lack of education, ageing, desperation associated with illness or bizarre personality traits. Vitamin E usage may be associated with such personality variables as personal disorganization or extroversion. Students are distrustful of the scientific community and Federal agencies as sources of product information. The need for consumer protection from misinformation provided by popular nutrition sources is discussed.     

Peer-to-Peer Value Through Social Capital in an Online Motor Neuron Disease Community

Millions of people affected by disability or chronic disease access social support and information through online health communities. These communities of common interest flourish on the Internet, with participants creating peer-to-peer value through social support and information exchange. This study observes a community of people affected by motor neuron disease creating value for themselves and each other within an online health community. The community is studied through the lens of social capital theory, a construct borrowed from the field of sociology that contributes to our understanding of why people gravitate towards these online communities for support and information. The results contribute increased awareness of how peer-to-peer value is created within online health communities and highlight the need for marketers to understand the implications of such communities on consumer behavior as it relates to health care.     

The Impact of the Rhode Island Catastrophic Health Insurance Plan

Under Rhode Island's statewide Catastrophic Health Insurance Plan (CHIP) in effect since January, 1975, and similar to the Long-Ribicoff National Health Insurance Proposal, Rhode Island pays catastrophic medical expenses over and above a “personal resource payment” (out-of-pocket expenses) that varies with income and amount and type of health insurance coverage. Those with qualified plans (plans providing more services) pay less out-of-pocket. Benefits accrue mainly to some middle income households. CHIP has increased demand for and prices for health insurance with qualifying coverage, and utilization of medical care. Similar impacts on a larger scale may be expected from any national health insurance program.     

Why People Do Not Always Follow the Doctor's Orders: The Role of Hope and Perceived Control

The lack of adherence to medical advice is a widely recognized health care concern with important implications for consumer well‐being. This study advances a model for better understanding adherence behaviors by incorporating the positive emotion of hope and consumer perceptions of control. Empirical testing of the model in the context of type 2 diabetes, a lifestyle‐changing chronic illness, shows that hope generates more patient adherence. Furthermore, individuals have higher hope when they believe they are capable of performing the actions their treatment requires, and/or that their health outcomes are under their physician's control. The results indicate that health care providers can play an important role in encouraging adherence behaviors by cultivating hope and customizing their interactions with patients. Interventions aimed at increasing patient self‐efficacy or promoting patients' beliefs that health outcomes are under their physician's control are two routes to building hope. Health initiatives aimed at increasing diabetes treatment adherence should consider alternatives beyond asking patients to “take control” of their diabetes.     

Consumer health beliefs and food supplement use by the elderly

Seven western states in the U.S.A. were surveyed by mail and telephone to assess consumer-health beliefs and the use of food supplements (vitamins and minerals) as part of the overall western region project. A 57.9% return resulted in a sample size of 1,730 adults and 528 of these were 60 years of age and over. The sample included significantly greater numbers of regular users of vitamins and mineral supplements than non-users or occasional users. More women than men were regular users. Compared with those who never used vitamin and mineral supplements, regular users had distinct patterns of health beliefs and practices. Regularly, they relied heavily on the medical profession for general health information. They obtained supplement and diet information from diet books and periodicals and also believed that taking vitamins and minerals prevented serious illness, reduced stress, prevented colds, skin problems, heart attacks, cancer, and other health problems. While they believed their overall well-being was improved through the use of supplements, their responses did not indicate that use of supplements ensured good health or that the current food supply filled nutritional needs. Conclusions are that specific educational programmes about the value and use of food supplements need to be designed for the target audience. Furthermore, all professionals who work in the large array of food service positions should share the responsibility for providing accurate information and advertising.     

Protecting children's privacy online: How parental mediation strategies affect website safeguard effectiveness

Concern toward children's safety in an online environment has resulted in demands for safeguards to protect their online privacy when involved with a wide variety of commercial websites. Unfortunately, little academic research has examined how effective safeguards are in limiting children's disclosure of information. We fill this void by examining how proposed safeguards may interact with various types of parental involvement in limiting children's willingness to disclose information online. The results of two studies involving preteen, young teen, and older teen children show that safeguard effectiveness depends on both the type of parental mediation and the particular age group. Implications are presented for retailers, educators, and parents.     

A Generalized Model of the Utilization of Professional Services

The determinants of the utilization of professional services has been widely studied in the case of the Andersen-Newman (1973) framework. It seems likely that this framework which includes predisposing, enabling and illness level factors as leading to health services utilization might be usefully extended to the analysis of all professional service usage will illness level changing to professional service need level. This paper adapts the P Andersen-Newman framework to all professiona services by reformulating the framework and adds a strategic marketing approach in discussing its application.     

The recognition and valuing of patient knowledge: a way forward

The health care that patients receive, particularly in acute care settings, is mainly based in biomedical knowledge. The scientific method of investigating health conditions has directly contributed to the development of this knowledge. This has made a significant contribution to increased survival rates, reduced recovery periods and extending the duration of life. The influence of consumerism on health‐care management has led to an expectation of increased patient involvement when making decisions about their treatment options. This assumes that the provision of information helps improve patients' understanding of the diagnosed health condition and assists them to make ‘good’ decisions. Accordingly, there is a greater focus on providing information to patients. The information provided to patients mostly involves explanation about the biomedical aspects of their health condition. However, patients also desire information about how the health condition will affect their everyday life. We call the understanding of the implications of this information ‘everyday knowledge’. Provision of this information can assist patients by helping them realize their expectations and providing reassurance to both patients and their significant others. Unfortunately, everyday knowledge that assists patients to understand and manage their daily life has not been as systematically researched or examined. While biomedical knowledge has been extensively developed and promoted through funding regimes, everyday knowledge has not benefited from the same support. The interactions in health‐care settings are influential in the generation and use of knowledge. Practises that encourage sensitivity by health professionals to each patient's situation need to be identified and implemented. An increased focus on the inclusion of everyday knowledge alongside biomedical knowledge is likely to enhance the relevance of the information that patients currently receive.     

Do Consumers Respond to Country-of-Origin Labelling?

Seafood was the first class of foods to fall under the 2002 US regulatory requirements for mandatory country-of-origin labelling (COOL). If this regulation created benefits for consumers, filling an information void by demanding information that the market did not, then there should have been an observable response in the demand for seafood. To gauge the impact, we examined markets most likely to respond. We estimated retail demand for shrimp, seafood that in the USA is largely sourced from Southeast Asia and has a history of raising food safety concerns. Our estimated demand systems included standard variables consistent with economic theory—price and expenditure changes, ongoing trends, and seasonality in consumption patterns. The demand systems also accounted for regulations that required country-of-origin labels for some, but not all, foods prior to COOL. Data came from a nationally representative panel of households that record retail food purchases, allowing us to construct relatively high-frequency market data suitable for testing for the presence of even short-lived impacts. Household demographic information allowed us to separately estimate demands by consumers most likely to respond to label information. The demand systems yielded reasonable price and expenditure elasticity estimates, but none of the variables related to COOL revealed evidence of an impact.     

Assessing the Influence of Coupon Collecting

This study fds a void in the literature in regards to couponing by investigating the influence of coupon collecting rather than what causes coupon redemption. The study more specifically ex- amines the relationship between coupon collecting and brand aware- ness. Several information processing models are used Lo help explain the potential influence of coupon collecting. The results show nearly Uuee-fourths of respondents mentioned the brand they collected a coupon for as their togof-mind brand for vari- ous product categories. These fmdings suggest that a couponing strate- gy may be used to boost a brand's position in consumer's minds, and be more economical than alternative marketing strategies.     

Information search in health care decision-making: a study of word-of-mouth and internet information users

This paper investigates how individual consumers may differ in their information search behavior in health care decision-making. Results indicate that most consumers still use word-of-mouth as a primary information source for health care decisions. However, usage of the Internet is increasing. The results of this study indicate that consumers who are most likely to use the Internet for health care information are single, younger, and less educated, whereas consumers who are most likely to use word-of-mouth are middle-aged, married, with higher income and higher education. Surprisingly, no significant gender difference was found in information search behavior for health care decision-making. The results also suggest that consumers with the highest tendency to use word-of-mouth are also the lowest users of the Internet in health care decision-making. Implications of these findings are discussed.