Schwartz (2015) - Consumers and Healthcare: The Reluctant Consumer
Introduction
HC is often seen as negative service > increases due to uncertainty whether and when ill-
health occurs
Responsibility of making wise HC decisions has shifted to individuals; this is due to advances
in medical knowledge and technology → making them more accountable
Consumer is better informed and more autonomous → decisions are complex and involve
difficult trade-offs
Focus of this chapter: factors that shape consumer health decisions
Understanding Health Risk
Risk perceptions are primary drivers of behavioral change
Risk = likelihood that an unfavourable event involving injury or loss will occur
In order for people to be deliberately healthier, they must know and believe that they are at
some risk of experiencing a negative event
Example of model: Health Belief Model → increased risk perceptions facilitated behaviors
that either promote good health or prevent bad health
→ it is not this simple, people do not always behave more healthfully when well informed of
the risks (think about smoking)
Later models of health risk perception attempted to better account for changes (or lack
thereof) in behavior by considering how people’s attitudes and intentions were shaped by risk
information
e.g. Theory of Reasoned Action: changes in behavior must follow actual intentions to change
→ based on perceptions regarding the importance of the problem, the risk of a negative
event, and observable norms drawn from the actions of others
→ critique: intention-behavior gap still exists
e.g. Tetanus shot study by Leventhal et al. > people with more detailed information did get
vaccin > cannot be explained by models that assume that awareness, attitudes, and
intentions are the primary drivers of behavior
Both groups were equally convinced about the benefits of getting tetanus shot
Theory of Planned Behavior: incorporate one’s sense of personal control in health decisions
Relatively large changes in intentions may still lead to only very small changes in behaviors
Increasingly, consumer health research is called upon to understand not only changes in
attitudes and intentions, but also how those psychological forces translate, or fail to translate,
into real health behaviors
One problem: fundamental assumption that risks are perceived accurately
, Nowadays, models reflect more common empirical finding that behaviors stem from how
much a person feels that she of he is at risk, sometimes regardless of the actual risk
i.e. health risk assessments are often subjective and malleable (= ‘kneedbaar’)
exposing people to information on health risks as a means of improving informed decision
making can certainly be effective in reducing harmful behaviors
To date, empirical evidence strongly supports the notion that risk perceptions provide the
best foundation for theoretical models of health behavior
e.g. highlighting the health-related risks of cigarette smoke to both smokers and those
around them continues to play a prominent role in public health
→ but be aware that in US this strategy was accompanied by many other regulatory
measures
Social pressure and the stigmatization of smoking have also played a significant role in
reducing smoking rates by making it culturally unacceptable
Highlighting risk can backfire by making people fearful and even less likely to act
Some people may stop processing information because it is too cognitively taxing to
integrate or too emotionally difficult to contemplate
Others may exhibit self-positivity bias → believe that they are less at risk of developing
health problems than the average person in their circumstances
emotions, experience and natural desire to regulate our mood → can lead to both under- and
overestimation
describing risks in relative vs. absolute terms makes people feel at greater risk
The framing of risk messages can become controversial when scientific evidence emerges to
question the value of certain medical products and procedures (e.g. mammograms > loss-
framed risk)
When scientific evidence refutes long-held beliefs or clashes with strong cultural norms that
tell us screening reduces risks and saves lives, there is understandable confusion among
consumers about what to do
→ increases when experts disagree about implications of the findings
difficult to know in advance whether highlighting risks to consumers will have positive or
negative effects on attitudes and behaviors
Trade-offs in Health and Healthcare
trade-offs in an effort to minimize risks → involve the price of health goods and services
few studies really confront the complex psychology of making trade-offs between health and
money
e.g. Rand Health Insurance Experiment: families were randomly assigned to different levels
of health insurance out-of-pocket cost sharing
goal: measure impact of cost sharing on HC consumption and medical outcomes
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