Determinants of Preventive Health Behaviors and Prospects for Incentivization
Claire WilliamsDecember 1, 2009
Motivation
Increasing prevalence of preventable, high cost diseases
Four chronic conditions ~75% of costs
New research linking behavior to costs Dee Edington, University of Michigan
New employer insurance initiatives 15% of employees 85% of costs
85% of employees 15% of costs
Data
2005 Medical Expenditure Panel Survey - Household Component (MEPS-HC)
Large, nationally representative sample
Collects information on: Medical care expenditure Medical care use Health status and conditions Health insurance coverage Demographic and socioeconomic characteristics
Table 1. Summary StatisticsAll
Age 33.92Male 0.475Married w/ Spouse Present 0.501Income 28.899Years of Education 10.409Employed 0.636Risky 0.226White 0.758Black 0.17Asian 0.038Other Race 0.035Hispanic 0.279Northeast 0.143South 0.39West 0.27Midwest 0.189MSA 0.821BMI 27.62Overweight 0.756Obese 0.523Perceived Health Status 0.881Physical Activity 0.542Smoke 0.208Regular Check Up 0.389% Reimbursed Office Visits 0.753Observations 33,961
Regression Results
Table 2. Results of Regular Check-ups Probit Model, Marginal Effects(1) (2) (3) (4)
% Reimbursed Office-Visits (0-1) 0.143*** 0.528*** 0.526*** 0.513***0.016 0.027 0.027 0.027
Age 0.006*** 0.006*** 0.006***0 0 0
Male -0.124*** -0.118*** -0.117***0.009 0.009 0.009
Married w/ Spouse Present 0.052*** 0.048*** 0.05***0.009 0.009 0.009
Income 0.002*** 0.001*** 0.001***0 0 0
Employed -0.087*** -0.09*** -0.092***0.011 0.012 0.012
Risky -0.04*** -0.041*** -0.039***0.01 0.01 0.01
Black 0.057*** 0.064*** 0.065***0.012 0.012 0.012
Asian -0.006 -0.009 -0.0010.022 0.022 0.022
Other Race (Non-White) 0.023 0.027 0.044*0.025 0.025 0.025
Hispanic -0.018 0.018 0.029**0.011 0.012 0.012
Years of Education 0.012*** 0.011***0.002 0.002
Northeast 0.121***0.013
South -0.0160.012
West -0.044***0.013
MSA 0.034***0.011
Observations 28065 15287 15183 15183
Table 3. Model 4 outcomes for three dependent variablesBlood
Pressure Check
PSA Breast Exam
% Reimbursed Office-Visits (0-1) 0.379*** 0.174*** 0.365***0.02 0.059 0.036
Age 0.004*** 0.021*** -0.001***0 0.001 0
Male -0.135 N/A N/A0.007 N/A N/A
Married w/ Spouse Present 0.032*** 0.087*** 0.099***0.007 0.019 0.011
Income 0.001*** 0.001** 0.002***0.0002 0.0003 0.0003
Employed -0.065*** -0.037 -0.0130.009 0.025 0.015
Risky -0.009 -0.035* -0.0180.008 0.02 0.015
Black 0.013 0.1*** 0.054***0.01 0.024 0.016
Asian -.098*** -0.144** -0.09**0.02 0.046 0.03
Other Race (Non-White) 0.006 -0.041 -0.0240.019 0.055 0.032
Hispanic -0.042*** -0.02 0.0070.01 0.03 0.016
Years of Education 0.009*** 0.024*** 0.013***0.001 0.003 0.002
Northeast 0.031*** 0.033 0.043**0.01 0.028 0.019
South -0.01 0.0289 -0.041**0.01 0.024 0.016
West -0.023*** 0.019 -0.0170.01 0.026 0.0018
MSA -0.013 0.032 0.0130.009 0.023 0.015
Observations 15183 3991 8041
Table 4. Model 4 outcomes for three dependent variables
Perceived Health Status
BMIRegular Exercise
% Reimbursed Office-Visits (0-1) -0.108*** 1.077*** -0.066**0.018 0.323 0.027
Age -0.002*** 0.015*** -0.002***0.0002 0.004 0.0003
Male -0.002 0.050 0.061***0.006 0.103 0.008
Married w/ Spouse Present 0.027*** 0.579*** -0.0110.006 0.105 0.009
Income 0.001*** -0.001 0.0005**0.0002 0.002 0.0002
Employed 0.12*** 0.208 0.063***0.009 0.141 0.012
Risky 0.006 -0.292* 0.028***0.007 0.121 0.01
Black -0.04*** 2.125*** -0.059***0.009 0.149 0.012
Asian 0.009 -2.993*** -0.073***0.016 0.261 0.022
Other Race (Non-White) -0.057** 1.482*** 0.0080.02 0.297 0.025
Hispanic -0.019* 0.696*** -0.072***0.009 0.146 0.012
Years of Education 0.009*** -0.093*** 0.014***0.001 0.018 0.001
Northeast -0.002 -0.562*** -0.0120.01 0.168 0.014
South -0.019*** -0.013 -0.0170.008 0.141 0.012
West 0.002 -0.388* 0.0110.009 0.157 0.013
MSA 0.024*** -0.641*** -0.019*0.008 0.133 0.011
Constant 27.412***0.429
Observations 15126 14800.000 15076
Case Studies Safeway Inc. “Healthy Measures”
Outcome based
King County “Healthy Incentives” Participation based
Middlebury College Work in Progress
Conclusion Results suggest that people respond to financial incentives for simple preventive care Furthermore incentives seem to increase awareness Key factors to encourage personal responsibility
Awareness Ability/Access Incentivization
Policy Implications