Preventive health screenings can detect health problems early enough to maximize treatment effectiveness, improving health quality and potentially reducing healthcare costs. Access to preventive care in Michigan is fundamental to ensuring the health of its residents as well as to minimizing healthcare costs for consumers, insurers, and the government. While the cost of preventive care under the Affordable Care Act will fall for many Michiganders, several barriers to utilization will likely remain. We propose a randomized field experiment in the metro-Detroit area that will enable us to answer three specific research questions of interest to researchers and policymakers:
1. What are the barriers to accessing preventive health care in Michigan, and how do they vary with demographic characteristics?
2. What are the impacts of information and incentives on individuals? take-up of preventive health care, and can inducing an endowment effect be a low-cost way to increase individuals? usage of preventive health care?
3. What are the short and medium-run impacts of incentivizing preventive health screenings on individuals? health care usage?
We plan to test the impact of information and incentives to encourage preventive health care in Michigan. Using random assignment to identify causal impacts, a methodology similar to that used in clinical medical trials, we will measure the effectiveness of providing information about where to obtain low-cost health screenings as well as the effect of offering $10 and $50 subsidies to encourage people to obtain health screenings at a nearby health clinic.
We plan to combine these incentives with a novel intervention that uses the insights of behavioral economics to encourage higher subsidy take-up. Among individuals offered a subsidy to obtain a health screening, some will receive a coupon card for the subsidy offer, while others will receive an inactive gift card. While both cards will help individuals remember to use the subsidy, the gift card endows the participant with the subsidy. Failing to activate a gift card may be seen as a loss, which is theorized to be more painful than missing out on an equivalent gain. In this case, we aim to measure the cost effectiveness of endowment effects to promote the use of subsidies. If endowing individuals with potential subsidies yields higher take-up rates, it will indicate that policymakers can use lower-cost incentives along with an endowment to maximize outreach effectiveness.
We conducted a pilot in 2013 that demonstrated the promise of this approach, but we require a larger sample size to fully investigate the impact of information and subsidies on demand for preventive healthcare. With support from the Blue Cross and Blue Shield of Michigan Foundation, we will enroll an additional 1,500 participants beginning in early 2015 (pending funding, we can begin as soon as June 2014). Our sample will consist of adults living in low and moderate-income neighborhoods in the metro Detroit area. In early 2016, we will conduct a nine-month follow-up survey in order to measure the medium-run impacts on healthcare usage.
The results of this project will be important to understand the nature and magnitude of barriers to preventive care, as well as to explore what steps can be taken to increase screening usage for a diverse population of Michigan residents. By applying findings from the behavioral economics literature, we can determine the impact of harnessing loss aversion as a way to maximize the impact of subsidies, which will be of great interest to academic researchers and may also yield more cost-effective options to increase take-up of preventive health care.