TY - JOUR T1 - Preferences, beliefs, and self-management of diabetes. JF - Health Serv Res Y1 - 2009 A1 - Frank A Sloan A1 - Padrón, Norma A A1 - Alyssa C Platt KW - Black or African American KW - Choice Behavior KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin KW - Health Knowledge, Attitudes, Practice KW - Health Status KW - Hispanic or Latino KW - Humans KW - Internal-External Control KW - Logistic Models KW - Longevity KW - Longitudinal Studies KW - Male KW - Patient Compliance KW - Risk Assessment KW - Self Care KW - Self-Assessment KW - Socioeconomic factors KW - Surveys and Questionnaires AB -

OBJECTIVE: To assess relationships between self-assessed control over life events, subjective beliefs about longevity, time and risk preference, and other factors on use of recommended care for diabetes mellitus (DM), self-assessed control of diabetes, general health, and laboratory measures of HbA1c levels.

DATA SOURCES: Health and Retirement Study (HRS) and 2003 HRS Diabetes Study (HRS-DS).

STUDY DESIGN: We used logit and ordered logit analyses to assess use of recommended care, and subjective and objective measures of health outcomes.

DATA COLLECTION: Secondary analysis of HRS and HRS-DS data.

PRINCIPAL FINDINGS: Individuals with higher self-assessed control over life events and higher subjective probabilities of living 10 years engaged in more recommended DM care practices and had better self-assessed DM control and general health. However, these beliefs did not influence HbA1c levels. More highly educated and cognitively able persons were more likely to follow care recommendations. There were differences by race/ethnicity in health outcomes, but not in health investment among Hispanics.

CONCLUSIONS: Individuals' beliefs about control over life events and longevity influenced health investment and subjective health outcomes, although these beliefs did not translate into differences in HbA1c levels. Hispanics may realize lower returns on health investments, at least for diabetes care.

PB - 44 VL - 44 IS - 3 N1 - PMID: 19674433 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19674433?dopt=Abstract U2 - PMC2699922 U4 - Diabetes Mellitus/Subjective phenomena/Health ER - TY - JOUR T1 - Economic theory and evidence on smoking behavior of adults. JF - Addiction Y1 - 2008 A1 - Frank A Sloan A1 - Wang, Yang KW - Adult KW - Aged KW - Aged, 80 and over KW - Choice Behavior KW - Costs and Cost Analysis KW - health policy KW - Humans KW - Impulsive Behavior KW - Middle Aged KW - Risk Factors KW - Smoking KW - Smoking cessation KW - Time Factors AB -

AIMS: To describe: (i) three alternative conceptual frameworks used by economists to study addictive behaviors: rational, imperfectly rational and irrational addiction; (ii) empirical economic evidence on each framework and specific channels to explain adult smoking matched to the frameworks; and (iii) policy implications for each framework.

METHODS: A systematic review and appraisal of important theoretical and empirical economic studies on smoking.

RESULTS: There is some empirical support for each framework. For rational and imperfectly rational addiction there is some evidence that anticipated future cigarette prices influence current cigarette consumption, and quitting costs are high for smokers. Smokers are more risk-tolerant in the financial domain than are others and tend to attach a lower value to being in good health. Findings on differences in rates of time preference by smoking status are mixed; however, short-term rates are higher than long-term rates for both smokers and non-smokers, a stylized fact consistent with hyperbolic discounting. The economic literature lends no empirical support to the view that mature adults smoke because they underestimate the probability of harm to health from smoking. In support of the irrationality framework, smokers tend to be more impulsive than others in domains not related directly to smoking, implying that they may be sensitive to cues that trigger smoking.

CONCLUSIONS: Much promising economic research uses the imperfectly rational addiction framework, but empirical research based on this framework is still in its infancy.

PB - 103 VL - 103 UR - http://dx.doi.org/10.1111/j.1360-0443.2008.02329.x IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18778387?dopt=Abstract U3 - 18778387 U4 - Addiction/cigarette prices/hyperbolic discounting/impulsivity/rationality/risk preference/time preferences/smoking ER - TY - JOUR T1 - End-of-life medical treatment choices: do survival chances and out-of-pocket costs matter? JF - Med Decis Making Y1 - 2008 A1 - Chao, Li-Wei A1 - José A Pagán A1 - Beth J Soldo KW - Aged KW - Choice Behavior KW - Female KW - Financing, Personal KW - Health Care Costs KW - Humans KW - Life Expectancy KW - Male KW - Medicare KW - Neoplasms KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

BACKGROUND: Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion.

OBJECTIVES: To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs.

METHODS: Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s.

RESULTS: Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects.

CONCLUSIONS: Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.

PB - 28 VL - 28 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18441252?dopt=Abstract U2 - PMC2587497 U4 - Economics of the Elderly/Medical Expenditures/Survival/Survivors/Saving ER - TY - JOUR T1 - Why don't people buy long-term-care insurance? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2006 A1 - Cramer, Anne Theisen A1 - Gail A Jensen KW - Aged KW - Choice Behavior KW - Commerce KW - Decision making KW - Demography KW - Female KW - Humans KW - Insurance, Health KW - Long-term Care KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVES: The objective of this article was to assess the determinants of an individual's decision to purchase long-term-care (LTC) insurance. This article focuses on the decision to purchase a new policy as opposed to renewing an existing policy. This study gave special consideration to the role of policy price, the savings associated with buying a policy now as opposed to later, the purchaser's education, and the purchaser's income.

METHODS: Using data from the 2002 Health and Retirement Survey, we estimated logistic regressions to model consumer decisions to purchase LTC insurance. We explored several alternative measures of the price of a policy.

RESULTS: Price was a significant determinant in decisions to purchase coverage. The demand for coverage, however, was price inelastic, with elasticities ranging from -0.23 to -0.87, depending on the specification of the model. The education level and income of the purchaser were also important.

DISCUSSION: This analysis provides the first estimates of price elasticity of demand for LTC insurance. The finding that demand is very price inelastic suggests that state initiatives that effectively subsidize premiums as a way of stimulating purchases are likely to meet with very limited success in the present environment.

PB - 61B VL - 61 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16855039?dopt=Abstract U4 - Insurance, Long Term Care ER - TY - JOUR T1 - Predictors of perceptions of involuntary retirement. JF - Gerontologist Y1 - 2005 A1 - Maximiliane E Szinovacz A1 - Adam Davey KW - Activities of Daily Living KW - Choice Behavior KW - Demography KW - Humans KW - Retirement KW - Social Perception KW - Socioeconomic factors KW - United States AB -

PURPOSE: Retirement is often treated as a voluntary transition, yet selected circumstances can restrict choice in retirement decision processes. We investigated conditions under which retirees perceive their retirement as "forced" rather than "wanted."

METHODS: Analyses relied on Waves 1-4 of the Health and Retirement Survey (N=1,160; 572 men and 588 women). Logistic regression models estimated the effects of background factors, choice and restricted choice conditions, and retirement contexts on perceptions of forced retirement.

RESULTS: Nearly one third of older workers perceived their retirement as forced. Such forced retirement reflects restricted choice through health limitations, job displacement, and care obligations. Other predictors include marital status, race, assets, benefits, job tenure, and off-time retirement.

IMPLICATIONS: Future research should establish personal and policy implications of forced retirement. Programs are needed to help older workers forced into retirement find alternative employment opportunities and to reduce the conditions leading to forced retirement.

PB - 45 VL - 45 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15695416?dopt=Abstract U4 - Retirement ER - TY - JOUR T1 - Pension decisions in a changing economy: gender, structure, and choice. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2000 A1 - Melissa A. Hardy A1 - Kim Shuey KW - Age Factors KW - Choice Behavior KW - Decision making KW - Female KW - Humans KW - Male KW - Middle Aged KW - Models, Economic KW - Pensions KW - United States AB -

OBJECTIVES: As responsibility for financial security in retirement becomes more individualized, understanding the distribution and determinants of savings behavior grows in importance. Employed men and women often gain access to their pension assets when they change jobs. In this study gender differences in pre-retirement access to and disposition of accumulated pension assets are examined.

METHODS: The authors used data from the Health and Retirement Study to model pension participation, disposition of pension assets, and use of cash settlements derived from a pension plan in a previous job. Logit models provided estimates of gender differences in access to pensions and the preservation of pension funds for retirement.

RESULTS: Women were less likely to have participated in employer-sponsored pension plans; more likely to cash out accumulated pension assets when they changed jobs; and, when job changes occurred at relatively young ages, equally likely to spend the settlement. However, by their late 40s, women were more likely to save the settlement, a net gender difference that increased with age at which the settlement was received.

DISCUSSION: The structure of employment compensation continues to place women at a disadvantage. Gender differences in earnings and fringe benefits not only affect current financial status, but also cast a shadow over future financial security. Although the gender gap in pension coverage has been reduced, women with pensions have access to lower benefits and less in accumulated assets. As these continuing deficits are addressed, enhancing women's tendency to save pension assets for retirement can help them build financial security.

PB - 55B VL - 55 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10985298?dopt=Abstract U4 - Age Factors/Choice Behavior/Decision Making/Female/Human/Middle Age/Models, Economic/Pensions/United States ER - TY - JOUR T1 - Preferences for surrogate decision makers, informal communication, and advance directives among community-dwelling elders: results from a national study. JF - Gerontologist Y1 - 2000 A1 - Faith P. Hopp KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Choice Behavior KW - Communication KW - Educational Status KW - Family KW - Female KW - Health education KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Needs Assessment KW - Surveys and Questionnaires KW - United States KW - White People AB -

This study, drawing on a nationally representative sample of community-dwelling adults aged 70 and older from the second wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, addresses the need for greater information on advance care planning among older adults. Older persons expect to draw on a diverse array of persons to make health care decisions for them when they are unable to do so, including spouses, when available, as well as younger generation members such as children and grandchildren. Completion of advance directives such as living wills and durable powers of attorney for health care was more common among White respondents than among African American respondents, and among high school- and college-educated respondents compared with those with less than a high school education. The results suggest the need to develop interventions aimed at strengthening knowledge and understanding of advance directives, particularly for African Americans and persons with lower levels of educational attainment. They further suggest the need for more research on the factors related to informal communication between older adults and their family members on issues related to advance care planning.

PB - 40 VL - 40 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10961034?dopt=Abstract U4 - Advance Directives/Psychology/Aged, 80 and Over/Blacks/Choice Behavior/Communication/Educational Status/Family/Female/Health Education/Health Status/Logistic Models/Needs Assessment/Whites ER -