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Hospital tiers in health insurance: balancing consumer choice with financial incentives.

Variations in efficiency and market power are generating wide variations in the prices charged by hospitals to health insurance plans. Insurers are developing new network structures that expose the consumer to some of the cost differences, to encourage but not mandate differential use of the more economical facilities. The three leading designs include hospital "tiers" within a single broad network, multiple-network products, and the replacement of copayments by coinsurance in HMO as well as PPO products. This paper describes the new network designs and evaluates the challenges they face in influencing consumers' behavior, incorporating information on clinical quality, and supporting medical education and uncompensated care.

Consumer Behavior↗

The growing threat of AIDS: how marketers must respond.

The author addresses the relationship between AIDS-related anxiety and the full range of consumer behavior activities. Relevant literature in the social sciences is summarized and a model of this relationship is posited. The model is used to explore consumers' potential reactions to the wide range of products that are expected to be introduced as the AIDS virus continues to spread into "mainstream" society. Differences in appropriate marketing-related practices are suggested on the premise that consumers may shift their focus, in part, from products designed to help them avoid contact with the AIDS virus to products designed to help them cope with the physical and emotional trauma of the disease.

Acquired Immunodeficiency Syndrome↗

Consumers' attitudes and behavior toward prescription drug advertising.

OBJECTIVE: To explore how consumers' characteristics interact with direct-to-consumer advertising (DTCA) to influence 2 behaviors: information seeking and asking for prescription. METHOD: A secondary data analysis was conducted using a subset of 1,102 consumers who responded to a 1998 national survey conducted by Prevention magazine. RESULTS: Being afflicted with chronic conditions and having positive attitudes toward DTCA were associated with the consumers' willingness to talk with doctors about the advertised drugs. Consumers who asked for prescriptions tended to agree that DTCA made prescription drugs appear harmless and helped them make their own decision. CONCLUSION: DTCA appears to have an influence on consumers' behavior.

Adolescent↗

Setting the public agenda for online health search: a white paper and action agenda.

BACKGROUND: Searches for health information are among the most common reasons that consumers use the Internet. Both consumers and quality experts have raised concerns about the quality of information on the Web and the ability of consumers to find accurate information that meets their needs. OBJECTIVE: To produce a national stakeholder-driven agenda for research, technical improvements, and education that will improve the results of consumer searches for health information on the Internet. METHODS: URAC, a national accreditation organization, and Consumer WebWatch (CWW), a project of Consumers Union (a consumer advocacy organization), conducted a review of factors influencing the results of online health searches. The organizations convened two stakeholder groups of consumers, quality experts, search engine experts, researchers, health-care providers, informatics specialists, and others. Meeting participants reviewed existing information and developed recommendations for improving the results of online consumer searches for health information. Participants were not asked to vote on or endorse the recommendations. Our working definition of a quality Web site was one that contained accurate, reliable, and complete information. RESULTS: The Internet has greatly improved access to health information for consumers. There is great variation in how consumers seek information via the Internet, and in how successful they are in searching for health information. Further, there is variation among Web sites, both in quality and accessibility. Many Web site features affect the capability of search engines to find and index them. CONCLUSIONS: Research is needed to define quality elements of Web sites that could be retrieved by search engines and understand how to meet the needs of different types of searchers. Technological research should seek to develop more sophisticated approaches for tagging information, and to develop searches that "learn" from consumer behavior. Finally, education initiatives are needed to help consumers search more effectively and to help them critically evaluate the information they find.

Community Participation↗

[Effects of BSE on consumer attitudes and behavior].

The extremely high media emphasis of the BSE issue during the period December 2000 to February 2001 has caused considerable short term public concern. A significant amount of this concern was due to an intensive communication of pictures. Pictures are "fast shots into the brain" (Kroeber-Riel). Pictured stimuli run under the cognitive control of the recipients effecting the consumer below the threshold of consciousness. However, the issue has fallen into oblivion very soon. In summer 2001 the public concern was not higher than before the BSE crisis. The perception of product quality regained a "normal level". The public concern has caused a considerable decline of the demand for beef and an increase of demand for substitutes and organic meat. When the media emphasis of the BSE issue diminished, the beef demand recovered but did not reach the pre-crisis level again. However, the BSE crisis has intensified animal welfare concerns, polarized public opinion about food and agriculture and had big effects in the political sphere. Furthermore, the BSE crisis has led to additional--politically supported--activities of the organic food suppliers causing a further growth of this market segment.

Animal Welfare↗

Understanding how elderly patients process drug information: a test of a theory of information processing.

PURPOSE: The goal of this research was to apply a well-known model of consumer behavior, the Elaboration Likelihood Model (ELM), to "direct-to-consumer" advertising of prescription drugs aimed at elderly consumers. In particular, the specific aim was to determine whether the effect of promotional aspects of consumer drug advertising predicted by the ELM could by demonstrated on elderly consumers' product attitudes and perceptions of risk. METHODS: Subject reaction to a fictitious drug advertisement was assessed using a 2 x 2 x 2 factorial design based on the theoretical concepts of the ELM. the advertisement message varied in the expertise of the product endorser, the expected involvement or interest level of the study subject, and the content of the advertisement message. RESULTS: Analysis of variance revealed a three-way interaction effect between involvement, argument quality, and source credibility on subjects' attitudes toward the product [F(1, 123) = 4.77, p = 0.03] and perceptions of risk [F(1, 118) = 3.22, p = 0.08]. The information content of the ads had an impact on subject's attitudes under the low involvement/low credibility condition but not the low involvement/high credibility condition. Under high involvement conditions, the information content of the ad impacted attitudes under both the high and low credibility conditions. CONCLUSIONS: It appears that the ELM may be a useful model for determining when elderly individuals are more likely to be influenced by the information content or the promotional aspects of consumer advertisements for prescription drugs.

Advertising↗

Introduction to some fundamental concepts in the economic analysis of dental care delivery.

This paper discusses some basic economic principles and concepts and how they relate to the analysis of dental care delivery. The fundamental theories of consumer behavior, profit maximization, information and transaction costs, and agency are considered. It is asserted that the information gap existing between patients and providers gives rise to a principal-agent problem, the operative element of this paper. The authors conclude that while under managed fee-for-service (MFFS) delivery systems, third-party administrators use financial, administrative, and utilization management tools to guide consumer and provider behavior, to reduce the size of the information gap, and achieve a more efficient allocation of resources, this does not occur under direct reimbursement (DR).

Budgets↗

A camera's view of consumer food-handling behaviors.

OBJECTIVE: To compare consumer food-handling behaviors with the Fight BAC! consumer food-safety recommendations. DESIGN: Subjects were videotaped in their home while preparing a meal. Videotapes were coded according to Fight BAC! recommendations. A food-safety survey was administered and temperature data was collected. SUBJECTS/SETTING: A market research company randomly recruited subjects by telephone. Ninety-nine consumers participated (92 women, seven men). STATISTICAL ANALYSIS PERFORMED: Descriptive statistics were used. RESULTS: Overall, subjects did not follow the Fight BAC! recommendations for safe food handling. Handwashing was inadequate. The average hand wash length was significantly lower than the 20-second recommendation. Only one-third of subjects' hand wash attempts were with soap. Surface cleaning was inadequate with only one-third of surfaces thoroughly cleaned. Moreover, one-third of subjects did not attempt to clean surfaces during food preparation. Nearly all subjects cross-contaminated raw meat, poultry, seafood, eggs, and/or unwashed vegetables with ready-to-eat foods multiple times during food preparation. Unwashed hands were the most common cross-contamination agent. Many subjects undercooked the meat and poultry entrees. Very few subjects used a food thermometer. APPLICATIONS/CONCLUSIONS: Consumers make many food-handling errors during food preparation, increasing their risk of foodborne illness. Dietetics professionals need to familiarize themselves with the Fight BAC! consumer food-safety recommendations; understand where consumers are making food-handling errors; increase food safety awareness; and educate consumers, especially those in high-risk populations, about safe food handling at home.

Consumer Product Safety↗

Public information and private search: evaluating the Patient Self-Determination Act.

Despite substantial regulatory efforts to improve consumer information regarding health and health care, little is known about the impact of such efforts on consumer behavior. This article examines the effect of federal legislation to enhance consumer information regarding the use of life-sustaining technology in end-of-life medical treatment decision making. Using a unique set of data abstracted from the medical records of six hundred elderly patients in nursing homes, the study finds a substantial impact of the law in promoting improved documentation of patient wishes for end-of-life medical care. Further, the data reveal that the effect of the law varies among identifiable subgroups. Consistent with the theory of search, the article demonstrates that the effects of regulatory efforts that promote the public provision of consumer information are greatest among individuals for whom information is most beneficial but for whom private search is costly. Implications for health policy are discussed.

Advance Directives↗

Effects of professional and media warnings about the association between aspirin use in children and Reye's syndrome.

The media played a central role in changing the use of aspirin among children with viral illness following reports of its association with a rare but deadly disease, Reye's syndrome (RS). It did so by alerting health professionals and parents about ways to prevent RS in children. Indeed, by the time aspirin product labeling was required by the FDA in 1986, most of the decline in RS incidence had already occurred. In the past, media-only health education campaigns have been relatively unsuccessful in achieving long-term changes in complex health behaviors. This article supports the theory that media warnings about the hazards of common products may successfully change consumer behaviors when the illness is devastating, the behavioral message is simple, acceptable and inexpensive alternatives are available, and the campaign is comprehensive, involving multiple professional groups to reinforce direct appeals to consumers.

Aspirin↗

Taking behavioralism seriously: some evidence of market manipulation.

Over the last ten to fifteen years, economists and legal scholars have become increasingly interested in and sensitive to behavioralist insights. In a companion article, Jon Hanson and Douglas Kysar argued that those scholars have nevertheless given short shrift to what is, at least for policymaking purposes, perhaps the most important lesson of the behavioralist research: individuals' perceptions and preferences are highly manipulable. According to Hanson and Kysar, one theoretical implication of that insight for products liability law is that manufacturers and marketers will manipulate the risk perceptions of consumers. Indeed, to survive in a competitive market, manufacturers and marketers must do so. In this Article, Hanson and Kysar present empirical evidence of market manipulation--a previously unrecognized source of market failure. The Article begins by surveying the extensive qualitative and quantitative marketing research and consumer behavioral studies that discern and influence consumer perceptions. It then provides evidence of market manipulation by reviewing common practices in everyday market settings, such as gas stations and supermarkets, and by examining familiar marketing approaches, such as environmentally oriented and fear-based advertising. Although consumers may be well-aware of those practices and approaches, they appear to be generally unaware of the extent to which those tactics are manipulative. The Article then focuses on the industry that has most depended upon market manipulation: the cigarette industry. Through decades of sophisticated marketing and public relations efforts, cigarette manufacturers have heightened consumer demand and lowered consumer risk perceptions. Because consumers are aware that smoking may pose significant health risks, the tobacco industry's success in manipulating risk perceptions constitutes especially strong evidence of the power of market manipulation. The Article concludes by arguing that the evidence of market manipulation may justify moving to a regime of enterprise liability. Indeed, according to Hanson and Kysar, the evidence of market manipulation confirms the intuitions of the first generation of product liability scholars, who worried about manufacturers' power to manipulate and called for just such a regime.

Advertising↗

The demand for post-acute and chronic care in nursing homes.

OBJECTIVES: Nursing homes provide care for persons with both post-acute and chronic conditions. In general, these two types of patients are associated with short and long stays, respectively. They also tend to be covered by different public or private insurance plans. The author investigated whether and how the demand for these two types of nursing home care differ. How alternative definitions of post-acute and chronic care nursing home stays affect estimates also was explored. METHODS: Data on a sample of elderly persons from the National Long-Term Care Channeling Demonstration was used. To account for market disequilibrium, demand was estimated using a bivariate probit with partial observability model. RESULTS: Differences were found in the demand for the two types of nursing home care. For instance, economic factors and functional and cognitive limitations were relatively more important in the demand for nursing home care for chronic conditions. Further, chronic care patients appeared more likely to face problems of access into nursing homes. Classifying nursing home stays by payer, rather than by length of stay, captured expectations at admission and appeared to reflect consumer behavior better. CONCLUSIONS: Differentiating post-acute and chronic care nursing home stays provides more meaningful information on consumer demand for nursing home care and will facilitate policy analysis in this area.

Aged↗

Mainstream legitimization of homosexual men through Valentine's Day gift-giving and consumption rituals.

Recently, the gay community has received increased attention from marketers through specially-made television commercials, direct mail pieces, and other media messages. However, little research in consumer behavior has examined the potential attitudinal and behavioral differences and similarities between heterosexuals and homosexuals. Specifically, this paper provides an exploratory look at the meaning and practices surrounding the consumer ritual of Valentine's Day from the perspective of homosexual men. Using depth interviews within an interpretative framework, our research suggests similarities exist for the celebration of Valentine's Day between homosexual and heterosexual singles, while differences may exist for the functions of Valentine's Day gift-giving between these groups. Some homosexual couples feel they cannot "legitimately participate" in the dominant rituals associated with the holiday due to oppression by a "heterosexual society". Marketing implications are discussed.

Adult↗

Competition and primary care in the United States: separating fact from fancy.

Competitive strategies have been advocated as the solution for the economic ills of the U.S. economy. During the 1980s many economists and health care practitioners are arguing that a competitive strategy will bring down health care costs; these plans emphasize the existence of perverse incentives which reward cost reducing behavior with less revenue. Competitive strategies assume the existence of a "health care marketplace." Historically, the United States health care sector has not conformed to the ideal of the competitive market because of the special characteristics involved in the production and consumption of health care. Consumers have the least power in the health care sector and yet most competitive proposals are explicitly directed at changing consumer behavior, especially in the area of primary care. Much evidence indicates that competitive plans inhibit consumers from using primary care services, increase long-term health care costs, and ultimately require more government regulatory action.

Cost-Benefit Analysis↗

The use of goal setting and contingency contracting for improving children's homework performance.

We examined the effects of goal setting and contingency contracting on children's homework performance. Subjects were 4 parent-child dyads in which the child exhibited substantial homework problems. Using a combination of multiple baseline and reversal (ABAB) designs, goal setting and contingency contracting produced significant improvements in children's homework accuracy. Two of the 4 subjects showed substantial improvements in on-task behavior. Consumer satisfaction with the procedures was supported by parent ratings conducted posttreatment.

Attention↗

A randomized clinical trial of triazolam in 3- to 5-year-olds.

Triazolam has shown promise as a sedative agent for use in pediatric dentistry. However, the efficacy of triazolam has not been previously examined in a placebo-controlled study. The present clinical trial used a two-group, randomized, double-blind study design to compare the efficacy of oral triazolam with that of a placebo. The primary hypothesis tested was that triazolam would reduce negative behaviors of pediatric dental patients compared with a placebo. A secondary hypothesis was that triazolam would increase the efficiency of dental treatment by reducing the need for time-consuming behavior management by the pediatric dentist. The subjects were 54 3- to 5-year-old children, randomly assigned to the drug and placebo groups. The active drug, 0.03 mg/kg triazolam (Halcion), or lactose placebo was given orally 30 min before dental treatment. Behavior management techniques commonly used in pediatric dentistry were used during dental treatment. A single pediatric dentist provided all of the dental treatment. The procedure included an inferior block anesthesia and careful attention to anesthesia effectiveness. All sessions were video-taped and the tapes coded for child and dentist behaviors by an independent observer. There were no statistically significant differences between the groups with respect to completion of dental treatment. There were no significant differences found in either the total time or the percent of time that the subjects exhibited disruptive movements, verbal or non-verbal distress. The total use of time in the dental chair was slightly higher in the placebo than in the drug group due to more time spent preparing the child. Contrary to preliminary reports in the literature, this investigation found little or no improvement in child behavior when triazolam was used as a sedative compared with a placebo. However, triazolam did shorten the length of dental treatment, primarily by reducing dentist time in preparing the child for the dental procedure (e.g., establishing rapport and shaping behavior).

Administration, Oral↗