OptiHealth: A Recommender Framework for Pareto Optimal Health Insurance Plans

Fernando Boccanera, Alexander Brodsky

Abstract

Choosing a health insurance plan, even when the plans are standardized, is a daunting task. Research has shown that the complexity of the task leads consumers to make non-optimal choices most of the time. While a number of systems were introduced to assist the selection of health insurance plans, they fail to significantly reduce the main causes of poor decisions. To address this problem, this paper proposes OptiHealth, a recommender framework for Pareto optimal selection of health insurance plans. The proposed framework is based on (1) actuarial analysis of medical data and a method to accurately estimate the expected annual cost tailored to specific individuals, (2) finding and presenting a small number of diversified Pareto optimal plans based on key performance indicators, and (3) allowing decision makers to iteratively conduct a trade-off analysis.

References

  1. Abaluck, J., Gruber, J., 2011. Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program. American Economic Review, 101(4): 1180-1210.
  2. CMS Medicare Plan Finder, 2016. https://www.medicare .gov/find-a-plan/questions/home.aspx
  3. Consumer Checkbook, 2016. https://www.checkbook.org/ newhig2/hig.cfm
  4. eHealthInsurance, 2016. https://www.ehealthinsurance.com/
  5. Frakt, A., 2014. Choosing a Health Plan is Hard, Even for a Health Economist (me). The Incidental Economist blog, October 29, 2014.
  6. Heiss, F., Leive, A., McFadden, D., Winter, J., 2013. Plan selection in Medicare Part D: Evidence from administrative data, Journal of Health Economics, Elsevier, vol. 32(6), pages 1325-1344.
  7. Healthcare.gov, 2016. https://www.healthcare.gov/
  8. Hibbard, J., Jewett, J., Legnini, M., Tusler, M., 1997a. Choosing A Health Plan: Do Large Employers Use The Data? Health Affairs, vol. 16, no. 6, pp. 172-180.
  9. Hibbard, J., Slovic, P., Jewett, J., 1997b. Informing consumer decisions in health care:implications from decision-making research. Milbank Quarterly 75(3):395-414.
  10. Johnson, J., Hershey, J., Meszaros, J., Kunreuther, H., 1993. Framing, probability distortions, insurance decisions. Journal of Risk and Uncertainty 7: 35-51.
  11. Johnson, E., Hassin, R., Baker, T., Bajger, A., Treuer, G., 2013. Can Consumers Make Affordable Care Affordable? The Value of Choice Architecture. PLoS ONE 8(12): e81521.
  12. Massachusetts Health Connector, 2016.
  13. Medical Expenditure Panel Survey, 2013. Agency for Healthcare Research and Quality. U.S. Department of Health & Human Resources. http://meps.ahrq.gov/mepsweb/
  14. McWilliams, J., Afendulis, Christopher, McGuire, T., Landon B., 2011, Complex Medicare Advantage Choices May Overwhelm Seniors, Health Affairs, 2011;30(9):1786-94.
  15. PBGH/CalPERS, 2016. https://calpers2015.chooser2.pbgh.org/
  16. Quincy, L., 2012. What's Behind the Door: Consumer Difficulties Selecting Health Plans. Health Policy Brief, January 2012, Consumer Union.
  17. Scanlon, D., Chernew, M., Lave, J., 1997. Consumer Health Plan Choice: Current Knowledge and Future Directions. Annual Review Public Health 1997, 18:507- 28
  18. Slovic, P., 1982. Toward Understanding and Improving Decisions. Human Performance and Productivity: Vol. 2, Information Processing and Decision Making, ed. W.C. Howell and E.A. Fleishman (Hillsdale, N.J.: Erlbaum, 1982), 157-183.
  19. Tversky, A., Kahneman, D., 1974. Judgment under Uncertainty: Heuristics and Biases. Science 27 Sep 1974: Vol. 185, Issue 4157, pp. 1124-1131. DOI: 10.1126/science.185.4157.1124.
Download


Paper Citation


in Harvard Style

Boccanera F. and Brodsky A. (2017). OptiHealth: A Recommender Framework for Pareto Optimal Health Insurance Plans . In Proceedings of the 19th International Conference on Enterprise Information Systems - Volume 1: ICEIS, ISBN 978-989-758-247-9, pages 599-609. DOI: 10.5220/0006334905990609


in Bibtex Style

@conference{iceis17,
author={Fernando Boccanera and Alexander Brodsky},
title={OptiHealth: A Recommender Framework for Pareto Optimal Health Insurance Plans},
booktitle={Proceedings of the 19th International Conference on Enterprise Information Systems - Volume 1: ICEIS,},
year={2017},
pages={599-609},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0006334905990609},
isbn={978-989-758-247-9},
}


in EndNote Style

TY - CONF
JO - Proceedings of the 19th International Conference on Enterprise Information Systems - Volume 1: ICEIS,
TI - OptiHealth: A Recommender Framework for Pareto Optimal Health Insurance Plans
SN - 978-989-758-247-9
AU - Boccanera F.
AU - Brodsky A.
PY - 2017
SP - 599
EP - 609
DO - 10.5220/0006334905990609