title: Can consumers make affordable care affordable? The value of choice architecture.
abstract: Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a "smart" default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year.
authors.affiliation: Center for Decision Sciences and Graduate School of Business, Columbia University, New York, New York, United States of America.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Johnson
authors.affiliation: Center for Rationality, The Hebrew University of Jerusalem. Jerusalem, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Hassin
authors.affiliation: Law School, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: Tom
authors.initials: T
authors.lastname: Baker
authors.affiliation: Department of Psychology, Columbia University, New York, New York, United States of America.
authors.forename: Allison T
authors.initials: AT
authors.lastname: Bajger
authors.affiliation: Abess Center for Ecosystem Science & Policy, University of Miami, Coral Gables, Florida, United States of America.
authors.forename: Galen
authors.initials: G
authors.lastname: Treuer
mesh_terms: D002755:Choice Behavior; D003256:Community Participation / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D058991:Patient Protection and Affordable Care Act; D014481:United States