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