A Randomized Experiment of the Split Benefit Health Insurance Reform to Reduce High-Cost, Low-Value Consumption

Traditional cost sharing for health care is stymied by limited patient wealth. The “split benefit” is a new way to reduce consumption of high-cost, low-value treatments for which the risk/benefit ratio is uncertain. When a physician prescribes a costly unproven procedure, the insurer could pay a portion of the benefit directly to the patient, creating a decision opportunity for the patient. The insurer saves the remainder, unless the patient consumes. In this paper, a vignette-based randomized controlled experiment with 1,800 respondents sought to test the potential efficacy of the split benefit. The intervention reduced the odds of consumption by about half. It did so regardless of scenario (cancer or cardiac stent), type of split (rebate, prepay, or health savings account), or amount of split (US$5,000 or US$15,000). Respondents viewed the insurer that paid a split as behaving fairly, as it preserved access and choice. Three-quarters of respondents supported such use in Medicare, which did not depend on political party affiliation. The reform is promising for further testing since it has the potential to decrease spending on low-value interventions, and thereby increase the value of the health care dollar

A Critical Perspective on Moral Neuroscience

In this paper, we highlight several historical developments in the neuroscience of ethics as well as recent advances that forecast the experimental research to come. We argue, in particular, that our understanding of the moral brain will benefit from the further use of a formal, mathematical approach to the construction and testing of alternative theories, such as that found in the field of neuroeconomics. The use of economic modeling to understand the psychological processes underlying distributional preferences and charitable giving is reviewed to illustrate this potential. We also consider some obstacles to such an approach, notably the challenge of capturing substantive moral values within a mathematical model

Mock Juror and Jury Assessments of Blinded Expert Witnesses

Expert witnesses\u27 findings may be biased because of partisan affiliation with the client who has hired them and because of financial incentives to offer an opinion favorable to this party. Blinding expert witnesses to which party is requesting their opinion is one solution to this problem. Previous research has shown that using a blinded expert in a mock medical malpractice trial increases mock jurors\u27 assessment of the expert\u27s credibility and results in more juror votes favoring the party employing this expert. The studies in this chapter extend prior research by examining the effects of blinded experts on civil mock jury deliberations and criminal mock juror verdicts. We found that blinding of experts had very substantial effects on jury deliberations, causing blinded experts to be viewed as more credible. Nonetheless, other case facts and competing cultural values were also very salient during deliberations. In addition, we demonstrated that use of blinded experts increased the likelihood of a not guilty verdict for the defense in a criminal trial, but did not have a similar effect for the prosecution

Mock Juror and Jury Assessments of Blinded Expert Witnesses

Expert witnesses\u27 findings may be biased because of partisan affiliation with the client who has hired them and because of financial incentives to offer an opinion favorable to this party. Blinding expert witnesses to which party is requesting their opinion is one solution to this problem. Previous research has shown that using a blinded expert in a mock medical malpractice trial increases mock jurors\u27 assessment of the expert\u27s credibility and results in more juror votes favoring the party employing this expert. The studies in this chapter extend prior research by examining the effects of blinded experts on civil mock jury deliberations and criminal mock juror verdicts. We found that blinding of experts had very substantial effects on jury deliberations, causing blinded experts to be viewed as more credible. Nonetheless, other case facts and competing cultural values were also very salient during deliberations. In addition, we demonstrated that use of blinded experts increased the likelihood of a not guilty verdict for the defense in a criminal trial, but did not have a similar effect for the prosecution

A Randomized Experiment of the Split Benefit Health Insurance Reform to Reduce High-Cost, Low-Value Consumption

Traditional cost sharing for health care is stymied by limited patient wealth. The “split benefit” is a new way to reduce consumption of high-cost, low-value treatments for which the risk/benefit ratio is uncertain. When a physician prescribes a costly unproven procedure, the insurer could pay a portion of the benefit directly to the patient, creating a decision opportunity for the patient. The insurer saves the remainder, unless the patient consumes. In this paper, a vignette-based randomized controlled experiment with 1,800 respondents sought to test the potential efficacy of the split benefit. The intervention reduced the odds of consumption by about half. It did so regardless of scenario (cancer or cardiac stent), type of split (rebate, prepay, or health savings account), or amount of split (US$5,000 or US$15,000). Respondents viewed the insurer that paid a split as behaving fairly, as it preserved access and choice. Three-quarters of respondents supported such use in Medicare, which did not depend on political party affiliation. The reform is promising for further testing since it has the potential to decrease spending on low-value interventions, and thereby increase the value of the health care dollar

Logistic regressions predicting a verdict of guilt.

<p>Null and residual deviances are shown at the bottom of the table, for assessing overall model fit.</p><p>° <i>p <</i> 0.10.</p><p>* <i>p</i> < 0.05.</p><p>** <i>p</i> < 0.01.</p><p>Logistic regressions predicting a verdict of guilt.</p