Can Moral Framing Drive Insurance Enrollment in the US?

To encourage health insurance uptake, marketers and policymakers have focused on consumers’ economic self-interest, attempting to show that insurance is a good deal or to sweeten the deal, with subsidies or penalties. Still, some consumers see insurance as a bad deal, either because they rationally exploit private risk information (“adverse selection”), or irrationally misperceive the value due to cognitive biases (e.g., optimism). As a result, about 30 million Americans remain uninsured, including many who could afford it.At the same time, polling suggests that Americans view health insurance through a moral lens, seeking to protect those with pre-existing conditions especially. In other markets, “green halo” and “noble edge” frames have been shown effective. As part of a broader research agenda on private law solutions to healthcare policy, we test whether moral framing could support insurance uptake. We report four phases of research.First, to understand current health insurance marketing in America, we collected the universe of advertisements from the state and Federal exchanges and coded a 10% sample for themes of economic self-interest versus three moral themes: helping others, helping community, or responsibility. In the 199 ads in which any theme appeared, 191 ads (96%, CI: 92-98%) centered on economic self-interest.Second, we enrolled 344 uninsured Americans in an online, vignette experiment where we offered various insurance plans. Over a baseline where 43.6% were willing to purchase insurance, we found that framing an economically-identical plan around generosity yielded an 11.8% higher uptake.Third, we conducted five focus groups with 32 adults, including two groups in Spanish. We explored variations in the frames and probed for resistance, to prepare for the next phase of research.Fourth, using an online advertising platform (Google), we purchased 5.6 million advertising impressions in English and Spanish, targeting higher-income Americans nationwide during the 2021 open-enrollment period. Consumers saw advertisements from a control group (highlighting economic self-interest, with real ads collected from the field) versus three experimental groups (helping others, helping community, or responsibility). We measured whether consumers clicked to “shop now” on the healthcare.gov website (1.01% click-through rate (CTR) in English and 1.38% CTR in Spanish at baseline). “Helping community” ads increased CTR over the control by 14.5% in English and by 33.7% in Spanish. Ads emphasizing “responsibility” increased CTR by 30.3% in English, though reduced CTR by 14.7% in Spanish. “Helping others” ads increased CTR by 9.8% in English but decreased CTR by 13.9% in Spanish. All of these results were significant at the .01 level and were robust to demographic controls and subgroup analyses, using individual and county-level covariates.Although the optimal approach varies, the status quo self-oriented message of economic rationality was not the top-performing approach for either language group. Scaled up to real-world advertising budgets, back-of-the-envelope extrapolation suggests that under moral framing, millions of additional Americans could be driven to shop for health insurance

Social Determinants of Smoking Behavior: The Healthy Twin Study, Korea

Objectives: The purpose of this study was to identify any influence of socioeconomic status on smoking and smokingcessation in a situation where genetic factors are controlled.Methods: The sample for this study was 2502 members of the twins and families cohort who participated in the KoreanHealthy Twins Study from 2005 to 2009. Groups of brothers or sisters, including twins and fraternal twins, were comparedin terms of smoking and smoking cessation behaviors according to differences in socioeconomic status and gender.Results: In a situation with complete control of genetic factors, results showed that the daily smoking amount, cumulativesmoking amount, and dependence on nicotine decreased with higher-status occupations, and the rate of smoking andamount of cumulative smoking decreased with higher levels of education. Regarding smoking cessation behavior, a higherlevel of education was associated with a lower smoking cessation rate, and no significant gender differences were found.Conclusions: Environmental factors had a stronger influence on smoking behavior than did genetic factors. Geneticfactors had greater influence on smoking cessation than did environmental factors; however, this requires verification infurther studies.Key words: Smoking, Smoking cessation, Social class, TwinsOAIID:oai:osos.snu.ac.kr:snu2012-01/102/0000040632/2SEQ:2PERF_CD:SNU2012-01EVAL_ITEM_CD:102USER_ID:0000040632ADJUST_YN:NEMP_ID:A077602DEPT_CD:902CITE_RATE:0FILENAME:2.Social Determinants of Smoking Behavior.pdfDEPT_NM:보건학과EMAIL:[email protected]:

Three Essays on Health Economics and Policy

My research focuses on a variety of topics on individual behavioral changes to external changes. By exploring how individual responses to policy interventions and environmental shocks, I aim to provide policy implications on how to promote health behavior and how to mitigate negative health impacts at an individual level. How individual responses to external shocks such as policy changes and environmental shocks has been less studied in the health economics and health policy literature. My research questions are important as a matter of informing implications for policy especially when the impacts of policy changes or environmental shocks on health are unclear

Can moral framing drive insurance enrollment in the United States?

To encourage health insurance uptake, marketers and policymakers have focused on consumers\u27 economic self-interest, attempting to show that insurance is a good deal or to sweeten the deal, with subsidies or penalties. Still, some consumers see insurance as a bad deal, either because they rationally exploit private risk information (“adverse selection”), or irrationally misperceive the value due to cognitive biases (e.g., optimism). As a result, about 30 million Americans remain uninsured, including many who could afford it. At the same time, polling suggests that Americans view health insurance through a moral lens, seeking to protect those with pre-existing conditions especially. In other markets, “green halo” and “noble edge” frames have been shown effective. As part of a broader research agenda on private law solutions to healthcare policy, we test whether moral framing could support insurance uptake. We report four phases of research. First, to understand current health insurance marketing in America, we collected the universe of advertisements from the state and federal exchanges and coded a 10% sample for themes of economic self-interest versus three moral themes: helping others, helping community, or responsibility. In the 199 ads in which any theme appeared, 191 ads centered on economic self-interest. Second, we enrolled 344 uninsured Americans in an online, vignette experiment where we offered various insurance plans. Over a baseline where 43.6% were willing to purchase insurance, we found that framing an economically identical plan around generosity yielded an 11.8% higher uptake. Third, we conducted five focus groups with 32 adults, including two groups in Spanish. We explored variations in the frames and probed for resistance, to prepare for the next phase of research. Fourth, using an online advertising platform (Google), we purchased 5.6 million advertising impressions in English and Spanish, targeting higher-income Americans nationwide during the 2021 open-enrollment period. Consumers saw advertisements from a control group (highlighting economic self-interest, with real ads collected from the field) versus three experimental groups (helping others, helping community, or responsibility). We measured whether consumers clicked to “shop now” on the HealthCare.gov website (1.01% click-through rate [CTR] in English and 1.38% CTR in Spanish at baseline). Helping community ads increased CTR over the control by 14.5% in English and by 33.7% in Spanish. Ads emphasizing responsibility increased CTR by 30.3% in English, though reduced CTR by 14.7% in Spanish. Helping others ads increased CTR by 9.8% in English but decreased CTR by 13.9% in Spanish. All of these results were significant at the 0.01 level and were robust to demographic controls and subgroup analyses, using individual and county-level covariates. Although the optimal approach varies, the status quo self-oriented message of economic rationality was not the top-performing approach for either language group. Scaled up to real-world advertising budgets, back-of-the-envelope extrapolation suggests that under moral framing, millions of additional Americans could be driven to shop for health insurance

Association between local government social expenditures and mortality levels in Korea

OBJECTIVES: We examined the association between social expenditures of the local government and the mortality level in Korea, 2004 to 2010. METHODS: We used social expenditure data of 230 local governments during 2004 to 2010 from the Social Expenditure Database prepared by the Korean Institute for Health and Social Affairs. Fixed effect panel data regression analysis was adopted to look for associations between social expenditures and age-standardized mortality and the premature death index. RESULTS: Social expenditures of local governments per capita was not significantly associated with standardized mortality but was associated with the premature death index (decline of 1.0 [for males] and 0.5 [for females] for each expenditure of 100 000 Korean won, i.e., approximately 100 US dollar). As an index of the voluntary effort of local governments, the self-managed project ratio was associated with a decline in the standardized mortality in females (decline of 0.4 for each increase of 1%). The share of health care was not significant. CONCLUSIONS: There were associations between social expenditures of the local government and the mortality level in Korea. In particular, social expenditures per capita were significantly associated with a decline in premature death. However, the voluntary efforts of local governments were not significantly related to the decline in premature death

In-situ Observation of High-Temperature Fracture Behaviour of 347 Stainless Steel Subjected to Simulated Welding Process

In-situ study on the high-temperature fracture behaviour of 347 stainless steel was carried out by using a confocal laser scanning microscope (CLSM). The welding microstructures of the 347 stainless steel were simulated by subjecting the steel specimen to solution and aging treatments. Undissolved NbC carbides were present within grains after solution treatment, and M23C6 carbides were preferentially formed at grain boundaries after subsequent aging treatment. The M23C6 carbides formed at grain boundaries worked as stress concentration sites and thus generated larger cracks during high-temperature tensile testing. In addition, grain boundary embrittlement was found to be a dominant mechanism for the high-temperature fracture of the 347 stainless steel because vacancy diffusion in the Cr-depleted zones enhances intergranular fracture due to the precipitation of M23C6 carbides at grain boundaries

Can Moral Framing Drive Insurance Enrollment in the US?

To encourage health insurance uptake, marketers and policymakers have focused on consumers’ economic self-interest, attempting to show that insurance is a good deal or to sweeten the deal, with subsidies or penalties. Still, some consumers see insurance as a bad deal, either because they rationally exploit private risk information (“adverse selection”), or irrationally misperceive the value due to cognitive biases (e.g., optimism). As a result, about 30 million Americans remain uninsured, including many who could afford it.At the same time, polling suggests that Americans view health insurance through a moral lens, seeking to protect those with pre-existing conditions especially. In other markets, “green halo” and “noble edge” frames have been shown effective. As part of a broader research agenda on private law solutions to healthcare policy, we test whether moral framing could support insurance uptake. We report four phases of research.First, to understand current health insurance marketing in America, we collected the universe of advertisements from the state and Federal exchanges and coded a 10% sample for themes of economic self-interest versus three moral themes: helping others, helping community, or responsibility. In the 199 ads in which any theme appeared, 191 ads (96%, CI: 92-98%) centered on economic self-interest.Second, we enrolled 344 uninsured Americans in an online, vignette experiment where we offered various insurance plans. Over a baseline where 43.6% were willing to purchase insurance, we found that framing an economically-identical plan around generosity yielded an 11.8% higher uptake.Third, we conducted five focus groups with 32 adults, including two groups in Spanish. We explored variations in the frames and probed for resistance, to prepare for the next phase of research.Fourth, using an online advertising platform (Google), we purchased 5.6 million advertising impressions in English and Spanish, targeting higher-income Americans nationwide during the 2021 open-enrollment period. Consumers saw advertisements from a control group (highlighting economic self-interest, with real ads collected from the field) versus three experimental groups (helping others, helping community, or responsibility). We measured whether consumers clicked to “shop now” on the healthcare.gov website (1.01% click-through rate (CTR) in English and 1.38% CTR in Spanish at baseline). “Helping community” ads increased CTR over the control by 14.5% in English and by 33.7% in Spanish. Ads emphasizing “responsibility” increased CTR by 30.3% in English, though reduced CTR by 14.7% in Spanish. “Helping others” ads increased CTR by 9.8% in English but decreased CTR by 13.9% in Spanish. All of these results were significant at the .01 level and were robust to demographic controls and subgroup analyses, using individual and county-level covariates.Although the optimal approach varies, the status quo self-oriented message of economic rationality was not the top-performing approach for either language group. Scaled up to real-world advertising budgets, back-of-the-envelope extrapolation suggests that under moral framing, millions of additional Americans could be driven to shop for health insurance