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The Role of Subjective Perceptions in Health Decisions: A Field Experiment among Disadvantaged Youth
Initial registration date
April 13, 2016
April 13, 2016 12:00 PM EDT
Other Primary Investigator(s)
Additional Trial Information
Disadvantaged youth are particularly at risk of under-investing in their health. Costs of healthcare and bias in health needs perceptions are likely to be key factors of under-investment. Relying on a randomized experiment, we find that providing them with personalized information both on public health insurance and on their health status based on a medical diagnosis raises their curative and preventive investments. More specifically, they are more likely to consult a psychologist and to use contraception, while depression and risky sexual behaviors are key issues in this population. In order to distinguish between the two barriers, financial constraints and underestimation of health needs, we also test a program providing information on public health insurance only. This limited program improves their level of medical coverage in the same way as the combined program, but it does not translate into higher health investments. These findings highlight the importance of taking into account the role of subjective perceptions of health needs when considering health decisions among disadvantaged youth.
Crepon, Bruno and Julie Pernaudet. 2016. "The Role of Subjective Perceptions in Health Decisions: A Field Experiment among Disadvantaged Youth." AEA RCT Registry. April 13.
The experiment tests two interventions.
The first intervention consists in encouraging young people to meet individually a social worker, whose role is to check their medical coverage is complete (basic and complementary insurance), up to date and adequate with their economic situation (typically, many young people are eligible to Universal Health Care coverage (CMU or CMU-C) and they do not know it) and in case it is not, explain to the young person how to update or change it and make sure she does it. The social worker also has to explain to the young person her rights and the functioning of her medical coverage, especially reimbursement procedures. The aim is that the youth who meet the social worker can afford health care at the end of the intervention and also know they can afford it. The second intervention consists in encouraging young people to see both the social worker and a doctor whose role is to make an individualized diagnosis of the state of health of the young people and make recommendations on the practitioner(s) to consult if need be, but the doctor in the intervention is not allowed to provide care or prescriptions, he can just direct young people to one practitioner or another. The doctor also has to provide information on health care, on health centers, on what to do in case of one symptom or another. The aim is that youth who meet the doctor become aware of their health needs, informed on the ways to meet these needs and feel more familiar with medicine and care. Another dimension of the doctor intervention concerns risk behavior. The doctor was supposed to assess, based on various questions, health behavior such as tobacco, alcohol or drug use, as well as sexual behavior. Both interventions are entrusted to experts and are individualized in order to make young people believe in the information provided and feel concerned about it.
Intervention Start Date
Intervention End Date
Primary Outcomes (end points)
1. Level of medical coverage and understanding of procedures
2. Health care utilization and health practices
3. Health status
Primary Outcomes (explanation)
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
The design consists in a two-arm treatment with random assignment of individuals in each of the two treatments or in the control group.
Experimental Design Details
Randomization done in office by a computer.
Was the treatment clustered?
Sample size: planned number of clusters
5 job centers:
Mission locale de Sénart
Mission locale de la Dhuys
Mission locale de Reims
Mission locale de Poitiers
Mission locale de Toulouse
Sample size: planned number of observations
1528 young people in the baseline survey, 1100 young people in the follow-up survey.
Sample size (or number of clusters) by treatment arms
501 young people in the social worker intervention.
532 young people in the social worker + doctor intervention.
495 young people in the control group.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Based on the initial sample and under the hypothesis of perfect compliance, we were able to detect MDE of approximately 0.17 standard deviation.
Based on the final sample and taking into consideration imperfect compliance, we are able to detect MDE of approximately 0.25 standard deviation.
INSTITUTIONAL REVIEW BOARDS (IRBs)
Comité d'Ethique de J-PAL Europe
IRB Approval Date
IRB Approval Number
Post Trial Information
Is the intervention completed?
Intervention Completion Date
January 01, 2013, 12:00 AM +00:00
Is data collection complete?
Data Collection Completion Date
January 01, 2013, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
5 job centers.
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
1100 young people.
Final Sample Size (or Number of Clusters) by Treatment Arms
364 young people in the social worker intervention, 381 in the doctor intervention, 355 in the control group.
Reports, Papers & Other Materials
Le projet PresaJe est né du constat, chez les jeunes les plus en difficultés, d’un faible recours
aux soins, en dépit d’un état de santé dégradé susceptible de porter préjudice à leur
insertion sociale et professionnelle. Le projet cherche à déterminer si une amélioration de la
couverture maladie des jeunes fréquentant les Missions locales ainsi qu’une éventuelle
consultation avec un médecin chargé d’établir un diagnostic de leur état de santé et de les
orienter si besoin vers les professionnels de santé adaptés permet d’augmenter leur recours
aux soins. Cette évaluation a impliqué plus de 1 500 jeunes répartis dans cinq Missions
locales, elle repose sur la méthodologie de l’allocation aléatoire entre groupe traitement et
REPORTS & OTHER MATERIALS