How Much Choice Do Seniors Want?: Survey
Results on the Medicare Prescription Drug Benefit
Janet Cummings Link*
Thomas Rice*
Yaniv Hanoch**
*Department of Health Services, UCLA School of Public Health
**Department of Psychology, University of Plymouth, England
Funding: Robert Wood Johnson Foundation
Investigator Award in Health Policy Research
Research Objective
 To investigate whether seniors prefer a large
number of Medicare drug plan choices versus
a handful of plans to choose from
 To examine the determinants of these beliefs
(demographics, SES, health status, political
party, and political ideation)
Background and Significance
 Passage of Medicare Part D resulted in a
stand-alone insurance policy
 In 2007, more than 50 plans available in all of
the contiguous 48 states
 Is this too much choice for seniors to
navigate?
Background and Significance
 Theory from economics and psychology posits that more
choice benefits consumers with the following assumptions:




Sufficient information about choices
Consumers can sift through choices
Consumers will not regret choices NOT made
Consumers do not dwell on what others have
 Newer research suggests that too much choice can have
adverse consequences
 Seniors may be especially prone to adverse effects of too
much choice
Hypotheses
 Seniors with greater cognitive abilities and resources will prefer
more choice
 Younger seniors will prefer more choice
 Higher Education and Income will be associated with preference for
more choice
 Political party affiliation and political ideology will be associated
with preference for choice
 Republicans will prefer more choice relative to Democrats and
Independents
 Conservatives will prefer more choice relative to Liberals and
Moderates
Data
 Nationally representative survey of 718
seniors conducted in November 2006
 Survey conducted jointly by the Kaiser Family
Foundation and Harvard School of Public
Health
Analytic Sample
Analytic deletions
718 seniors interviewed
65 who responded “Don’t know”
or “Refused” for outcome
variable
653 seniors without missing
information for dependent
variable
25 observations missing on
one or more of the following:
628 seniors without
missing information for
key explanatory variables
Age, marital status, self-rated
health, education, race
Variables
 Dependent Variable (Dichotomous)
• Which statement better reflects your opinion:
Medicare should offer seniors dozens of drug plans
so individuals can select their own plan to meet their
needs OR Medicare should select a handful of drug
plans that meet certain standards, to make it easier
for seniors to pick among those plans
Variables
 Explanatory Variables
• Demographics: Age (indicator for 75+), Gender, Marital status
Race/Ethnicity (White, Black, Other),
• Socioeconomic Status: Education, Income
• Health Status: Self-rated health (indicator for fair/poor), Indicator for
whether Senior takes medication
• Region and Urban Status
• Political Party: Republican, Democrat, Independent, Other
• Political Ideology: Conservative, Liberal, Moderate, Unknown
Descriptive Statistics for Analytic Sample
Proportion
Prefer Dozens of Plans
31.5%
Prefer Handful of Plans
68.5%
Female
57.3%
White
88.4%
High school degree or less
40.9%
Income less than $40,000
51.4%
Self-reported health fair/poor
20.4%
Take medication
86.6%
Key Results From Logistic Regression
Outcome Variable: Prefer dozens of plans (vs. prefer handful)
Variable
Odds Ratio
95% Conf. Interval
Age
0.74
0.51, 1.07
Black
2.60**
1.15, 5.90
Other
1.37
0.69, 2.72
0.47**
0.25, 0.86
0.80
0.43, 1.47
College Graduate
0.52**
0.27, 0.99
Liberal
0.62*
0.36, 1.08
Moderate
0.64**
0.42, 0.97
0.53
0.17, 1.66
High School Graduate
Some College
Views unknown
*p<0.10, **p<0.05
Policy Implications
Maintain the status quo
Reduce the number of drug plan
choices offered to seniors
Standardize drug plans