The role of prospect theory in screening behavior decision-making in a health-insured population of South Africa

Background: Prospect theory suggests that people avoid risks when faced with the benefits of a decision but take risks when faced with the costs of a decision. Screening for diseases can be defined as a ‘risk’, in the context of uncertainty. The outcome can either be a ‘benefit’ of good health or a ‘cost’ of ill health or poor-quality health. Purpose: To assess whether prospect theory can predict screening behavior in the context of a chronic disease diagnosis as well as the exposure to incentives to screen. Methods: A retrospective longitudinal case-control study for the period 2008-2011 was conducted using a random 1% sample of 170,471 health-insured members, assessing screening for cancers, chronic diseases of lifestyle and HIV, some of whom voluntarily join an incentivized wellness program. Results: Individuals diagnosed with a chronic disease screened up to 9.0% less for some diseases over time. Mammogram screening however increased (p<0.001). Where a family member was diagnosed with a chronic disease, individual screening decreased up to 8.6%. Similarly females in families where a member was diagnosed with a chronic disease screened more for breast cancer (p<0.001). Males were more sensitive to incentives only for HIV screening (p<0.001), while the female responses to incentives were inconsistent. Conclusion: A chronic disease diagnosis or the risk of developing a chronic disease resulted in reduced future screening behavior for most diseases. The role of incentives was inconsistent. Prospect theory adequately predicts screening behavior when diagnosed or faced with a possible chronic disease diagnosis for most screening tests except for females screening for breast cancer

Predictors of adherence to screening guidelines for chronic diseases of lifestyle, cancers, and HIV in a health-insured population in South Africa

Background: Adherence to screening guidelines has been widely accepted to reduce morbidity, mortality, and cost outcomes. The aim of this study was to identify predictors of adherence to screening guidelines for chronic diseases of lifestyle (CDL), cancers, and HIV in a health-insured population in South Africa, some of whom voluntarily opt into a wellness program that incentivizes screening. Method: A cross-sectional study for the period 2007-2011 was conducted using a random sample of 170,471 health insurance members from a single insurer. Adherence to screening guidelines was calculated from medical claims data. Results: Adherence to screening guidelines ranged from 1.1% for colorectal cancer to 40.9% for cholesterol screening. Members of the wellness program were up to three times more likely to screen for diseases (odds ratio [OR]=3.2 for HIV screening, confidence interval [CI]=2.753.73). Plan type (full comprehensive plan) was most strongly associated with cholesterol screening (OR=3.53, CI=3.273.80), and most negatively associated (hospital-only core plan) with cervical cancer screening (OR=0.44, CI=0.280.70). Gender was a negative predictor for glucose screening (OR=0.88, CI=0.820.96). Provincial residence was most strongly associated with cervical cancer screening (OR=1.89, CI=0.655.54). Conclusion: Adherence to screening recommendations was <50%. Plan type, gender, provincial residence, and belonging to an incentivized wellness program were associated with disproportionate utilization of screening services, even with equal payment access

Provincial screening rates for chronic diseases of lifestyle, cancers and HIV in a health-insured population

Background. Screening for asymptomatic diseases can reduce the burden of morbidity and mortality in all population groups. There is widespread geographical variation in the quality of care. Few data are available on national screening rates in South Africa and how these vary across the provinces. Objective. To examine screening rates for chronic diseases of lifestyle (CDL), HIV and cancer in a privately insured population for a single insurer across all nine provinces in South Africa, and to determine whether or not there are any differences between the provinces. Method. Screening rates were calculated as the proportion of eligible members who had received screening tests during 2011 in each province. Mean screening rates were compared between Gauteng and the other eight provinces. Results. Nationwide screening rates were 20.5% for CDL, 8.2% for HIV and 31.9% for cancer. Despite similar insurance coverage, screening rates ranged from 0.3% to 0.95% lower in other provinces compared with Gauteng. Of all the provinces, Gauteng had the highest annual screening rates for CDL, breast cancer, prostate cancer and HIV (

Screening practices of a health insured population and the role of behavioural economics

Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Health Sciences, 2015

Framing preventive care messaging and cervical cancer screening in a health-insured population in South Africa: implications for population-based communication?

The impact of health message framing on cervical cancer screening uptake is poorly understood. We undertook a prospective randomized control study between August 2013 and February 2014 within a health-insuered population. The study consisted of 748 females, aged 21–65 years who had not had a Pap smear in the previous 3 years and were randomly selected to receive either a loss-framed, gain-framed, or neutral health message (control) regarding cervical cancer screening via email. Pap smear uptake was determined from medical claims data. The median age was 43 years (interquartile range: 26–60 years). Overall Pap smear screening rate was found to be 8.36 percent (confidence interval: 8.08%−8.64%). Screening rate in the control group was 9.58 percent (confidence interval: 9.29%−9.87%), 5.71 percent (confidence interval: 5.48%−6.98%) in the gain-framed group, and 8.53 percent (confidence interval: 8.24%−8.81%) in the loss-framed group. Statistically there was no difference between the screening rates of the groups (p = 0.75). Females were 43 percent (odds ratio = 0.57) less likely to have a Pap smear if exposed to a gain-framed message, compared to a neutral-framed message; however, this finding was non-significant (p = 0.13). When receiving a loss-framed message, females were only 23 percent (odds ratio = 0.87) less likely to have a Pap smear compared to a neutral-framed message, also not significant (p = 0.69). In addition, further age stratification revealed no differences in Pap smear uptake between different age groups. These findings indicate that Pap smear uptake in this health-insured population is low, with no difference in exposure to differently framed health messages when emailed. Framing of health messages may not be a significant consideration when constructing population-based communication through emails