Abstract
Many patients expect their doctor to help them choose a Medicare prescription drug plan. Whether the size of the choice set affects clinicians’ decision processes and strategy selection, and the quality of their choice, as it does their older patients, is an important question with serious financial consequences. Seventy medical students and internal medicine residents completed a within-subject design using Mouselab, a computer program that allows the information-acquisition process to be examined. We examined highly numerate physician trainees’ decision processes, strategy, and their ability to pick the cheapest drug plan—as price was deemed the most important factor in Medicare beneficiaries’ plan choice—from either 3 or 9 drug plans. Before adjustment, participants were significantly more likely to identify the lowest cost plan when facing three versus nine choices (67.3% vs. 32.8%, p<0.01) and paid significantly less in excess premiums ($60.00 vs. $128.51, p<0.01). Compared to the three-plan condition, in the nine-plan condition participants spent significantly less time acquiring information on each attribute (p<0.05) and were more likely to employ decision strategies focusing on comparing alternate plans across a single attribute (search pattern, p<0.05). After adjusting for decision process and strategy, numeracy, and amount of medical training, the odds were 10.75 times higher that trainees would choose the lowest cost Medicare Part D drug plan when facing 3 versus 9 drug plans (p<0.05). Although employing more efficient search strategies in the complex choice environment, physician trainees experienced similar difficulty in choosing the lowest cost prescription drug plans as older patients do. Our results add further evidence that simplifications to the Medicare Part D decision environment are needed and suggest physicians’ role in their patients’ Part D choices may be most productive when assisting seniors with forecasting their expected medication needs and then referring them to the Medicare website or helpline.
Highlights
The Medicare Prescription Drug, Improvement, and Modernization Act of 2006 (Medicare Part D) is one of the most important changes to the U.S health care system
How should we evaluate clinicians’ decision abilities in regard to the Medicare Part D program? Physician trainees represent an important population in which to evaluate decision making because they possess the essential cognitive skills to make an informed decision if given sufficient information about the drug plans, even though they have likely had little exposure to the drug plan choice in the field
Aside from examining a timely, policy-relevant issue, we augment previous research by (a) varying the number of Medicare drug plans physician trainees’ evaluated, (b) including objective outcome criteria—namely, whether trainees chose the cheapest drug plan, and (c) controlling for decision process and strategy variables that may be important intermediaries of the choice-size effect found among clinical decision makers
Summary
The Medicare Prescription Drug, Improvement, and Modernization Act of 2006 (Medicare Part D) is one of the most important changes to the U.S health care system. Even though Medicare offers a range of resources (e.g., website, toll-free help lines) to aid older adults in choosing a drug plan, relatively few people use them [15] Using Mouselab confers a key comparative advantage to earlier investigations This is an important omission, as the strategies employed could influence the decision outcome for physician trainees as they do for older adults [7]. Aside from examining a timely, policy-relevant issue, we augment previous research by (a) varying the number of Medicare drug plans physician trainees’ evaluated (either three or nine), (b) including objective outcome criteria—namely, whether trainees chose the cheapest drug plan (and the amount of money lost if a higher cost plan was chosen), and (c) controlling for decision process and strategy variables that may be important intermediaries of the choice-size effect found among clinical decision makers. We hypothesized that medical students and residents would employ less efficient search strategies as the choice became more complex (i.e., nine vs. three drug plans) and that a larger drug plan menu would lead to poorer performance—that is, not choosing the lowest cost plan—independent of amount of medical training (i.e., student or resident) and decision-making strategy
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