title: Choice, numeracy, and physicians-in-training performance: the case of Medicare Part D.
abstract: OBJECTIVE
  In this study, we examined the effect of choice-set size and numeracy levels on a physician-in-training's ability to choose appropriate Medicare drug plans.
  
  
  METHODS
  Medical students and internal medicine residents (N = 100) were randomly assigned to 1 of 3 surveys, differing only in the number of plans to be evaluated (3, 10, and 20). After reviewing information about stand-alone Medicare prescription drug plans, participants answered questions about what plan they would advise 2 hypothetical patients to choose on the basis of a brief summary of the relevant concerns of each patient. Participants also completed an 11-item numeracy scale.
  
  
  METHODS
  Ability to answer correctly questions about hypothetical Medicare Part D insurance plans and numeracy levels.
  
  
  RESULTS
  Consistent with our hypotheses, increases in choice sets correlated significantly with fewer correct answers, and higher numeracy levels were associated with more correct answers. Hence, our data further highlight the role of numeracy in financial- and health-related decision making, and also raise concerns about physicians' ability to help patients choose the optimal Part D plan.
  
  
  CONCLUSIONS
  Our data indicate that even physicians-in-training perform more poorly when choice size is larger, thus raising concerns about the capacity of physicians-in-training to successfully navigate Medicare Part D and help their patients pick the best drug plan. Our results also illustrate the importance of numeracy in evaluating insurance-related information and the need for enhancing numeracy skills among medical students and physicians.
authors.affiliation: School of Psychology, University of Plymouth, Plymouth, England. yaniv.hanoch@plymouth.ac.uk
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Hanoch
authors.forename: Talya
authors.initials: T
authors.lastname: Miron-Shatz
authors.forename: Helen
authors.initials: H
authors.lastname: Cole
authors.forename: Mary
authors.initials: M
authors.lastname: Himmelstein
authors.forename: Alex D
authors.initials: AD
authors.lastname: Federman
mesh_terms: D000328:Adult; D002755:Choice Behavior; D032882:Comprehension; D003657:Decision Making; D011307:Drug Prescriptions / Q000191:economics; D005260:Female; D005569:Formularies as Topic; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D008297:Male; D054524:Medicare Part D / Q000191:economics / Q000706:statistics & numerical data*; D010820:Physicians; D013223:Statistics as Topic; D013337:Students, Medical / Q000523:psychology*; D014481:United States; D055815:Young Adult