Changes in Medical and Cost Uncertainty and the Health Seeking Decision: Vignette Experiment in Pakistan

Last registered on November 30, 2023

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Pre-Trial

Trial Information

General Information

Title

Changes in Medical and Cost Uncertainty and the Health Seeking Decision: Vignette Experiment in Pakistan

RCT ID

AEARCTR-0012326

Initial registration date

October 19, 2023

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published

November 01, 2023, 2:32 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated

November 30, 2023, 6:05 AM EST

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country

Pakistan

Region

Khyber Pakhtunkhwa

Primary Investigator

Name

Lisa Rogge

Affiliation

FAU Erlangen-Nürnberg

Contact Primary Investigator

Other Primary Investigator(s)

PI Name

Alina Imping

PI Affiliation

FAU Erlangen-Nürnberg

Contact Investigator

PI Name

Andreas Landmann

PI Affiliation

FAU Erlangen-Nürnberg

Contact Investigator

Additional Trial Information

Status

On going

Start date

2023-11-21

End date

2024-01-31

Keywords

Behavior, Health

Additional Keywords

Cost uncertainty, medical uncertainty, healthcare decision

JEL code(s)

Secondary IDs

Prior work

This trial does not extend or rely on any prior RCTs.

Abstract

Health care decisions are sometimes a matter of life and death, but also their financial consequences can be disastrous for many households around the world. While one can imagine how the fear of making an expensive mistake may deter households from making otherwise sensible health care choices, there is almost no scientific evidence on the importance and joint role of medical and financial uncertainty. In this project, we first provide theoretical insights based on simulation exercises and develop a novel measurement instrument for medical and cost uncertainty using hypothetical health scenarios (vignettes). Initial analyses from data collected using this instrument with low-income households in Pakistan reveal that on top of many biases, both medical as well as cost uncertainty in health care decisions exist and may deter sensible health investments, in line with the theoretical predictions. As these results indicate potentially large dividends to providing accurate information, we are now conducting an extended vignette survey that includes three within-survey information interventions targeted at changing medical or cost uncertainty separately or jointly. With this RCT, we aim to test in two intervention stages whether: i) the interventions reduce biases and uncertainties; ii) the interventions change the hypothetical health seeking decision; and iii) the joint intervention induces larger changes.

External Link(s)

Registration Citation

Citation

Imping, Alina, Andreas Landmann and Lisa Rogge. 2023. "Changes in Medical and Cost Uncertainty and the Health Seeking Decision: Vignette Experiment in Pakistan." AEA RCT Registry. November 30. https://doi.org/10.1257/rct.12326-1.1

Sponsors & Partners

Experimental Details

Interventions

Intervention(s)

Intervention Start Date

2023-11-21

Intervention End Date

2024-01-31

Primary Outcomes

Primary Outcomes (end points)

Hypothetical healthcare decision (whether and where to seek care, ranking) before and after overview
Scenario- and facility-specific expected probability to get better, cost, medical and cost uncertainty

Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)

Secondary Outcomes (explanation)

Experimental Design

The experiment will be fielded within a household survey with low-income households in four districts in Khyber Pakhtunkhwa, Pakistan. It is part of a game-like survey tool that asks respondents to imagine being exposed to a health shock that is defined by a health vignette script, assess medical and cost uncertainties for six care-seeking options and finally take a hypothetical decision for one of these six options. Each respondent is presented with two health scenarios subsequently: one light scenario that does not require formal medical care (light fever) and one severe scenario (randomly selected from heart disease and appendicitis).
Within each scenario, there are two stages of interventions: first, respondents are randomly allocated to one of four equally sized groups: one control group that does not receive any additional information, and three treatment groups that receive additional information within the vignette: a) targeted at medical uncertainty (nature of health shock, recommended treatment and level of care); b) targeted at cost uncertainty (health insurance coverage); and c) information content of a) and b) combined. This information content is designed in a way that could also be communicated via a medical helpline. After presenting the vignette and information, facility-specific expected probability to get better, expected costs, medical and cost uncertainty are elicited followed by the first hypothetical healthcare decision. In the second intervention stage, all respondents are presented with an overview of their reported facility-specific expectations. Then, within treatment groups a)-c), half of the respondents will see an overview of all their answers like the control group, and the other (randomly selected) half will see the overview without medical uncertainty (a), cost uncertainty at secondary facilities (b) or both (c).
We will conduct a results-blind analysis before receiving the full data including treatment allocation.

Experimental Design Details

Randomization Method

Randomization on tablet within survey form at the time of the interview

Randomization Unit

Individual

Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters

4,000 households with one respondent each

Sample size: planned number of observations

4,000 households with one respondent each

Sample size (or number of clusters) by treatment arms

Control group: 1,000 respondents
Medical information treatment stage 1: 1,000 respondents; stage 2: 500 control overview and 500 overview without medical uncertainty
Cost information treatment stage 1: 1,000 respondents; stage 2: 500 control overview and 500 overview without cost uncertainty
Medical and cost information treatment stage 1: 1,000 respondents; stage 2: 500 control overview and 500 overview without medical and cost uncertainty

Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Supporting Documents and Materials

IRB