Factors Associated With Choice in Health Insurance Decisions

Following an earlier exploratory survey of health insurance choice and decision-making, and an extensive literature review, a survey was carried out using as a population the employees of two large organisations. The objectives were (a) to extend the earlier survey in content and to a larger population; and (b) to gather information on reasons for choice and information sought and used in making decisions. The decision to insure and level of cover chosen were related to expected characteristics such as age, income and marital status together with history of medical expenses. History of hospital costs played a lesser role in choice of level of cover. Neither dependents nor health status nor expectations of costs appeared to be important and, although the proportion of insured was high, the population and their families were very healthy. In general, information sought and used was meagre and there is considerable support for concluding that decisions are not based on considered analysis of risks, costs and available options. Rather it would appear that decisions are related to general notions of risk aversion, the influence of media coverage of health care matters and aggressive advertising by the health funds. For those who did not insure, ideological factors - private enterprise medicine and rights to health care - were important.