Psychology, Department of


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A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Psychology, Under the Supervision of Professor Richard Wiener. Lincoln, Nebraska: April, 2012

Copyright (c) 2012 Michael J. Holtje


This investigation examined the role of “loss aversion” and consumers’ motivational orientations in the context of healthcare purchasing under the individual account paradigm and the defined benefit (insurance) paradigm. Specifically, this dissertation investigated (1) whether Health Savings Accounts (HSAs) encourage more prudent health care spending compared to traditional health insurance plans and (2) the impact of individuals' motivational preferences (either towards “gains” or towards “losses”) between decision tasks under each type of health plan.

Three experiments varied the type of healthcare plan that consumers had and the manner in which they received information (either as a “gain” or “loss”). The experiments examined (a) intentions to obtain skin cancer screening and willingness to pay for cancer screening, (b) intentions to obtain an immunization injection and willingness to pay for it, and (c) preferred treatment option in the face of an imagined lung cancer and willingness to pay for each of the two possible treatments.

The results reveal several interesting findings. Individuals’ knowledge about their healthcare plans was consistently a significant factor. Individuals with a high degree of knowledge would spend less money on healthcare services than would individuals with less knowledge.

Individuals’ motivational orientations were also consistently influential. A persistent motivational tendency towards “promotion” concerns increased the likelihood that individuals would obtain certain healthcare services and enhanced the amount of money participants would spend on other services. Conversely, a persistent motivational tendency towards “prevention” concerns decreased the likelihood that individuals would obtain certain healthcare services and decreased the amount of money individuals would spend on other services.

Moreover, the experiments yielded some evidence of loss aversion, albeit inconsistently. The findings support the conclusion that the framing of healthcare information can impact the choice-behaviors of healthcare consumers.

As a whole, this investigation helps advance our understanding of how the individual account paradigm interfaces with decision making errors and how “loss aversion” may impact healthcare choices. The results have implications for both psychological theories of decision making and healthcare policy.

Adviser: Richard Wiener