Can consumers make affordable care affordable? The value of choice architecture

Eric J. Johnson, Ran Hassin, Tom Baker, Allison T. Bajger, Galen Treuer

Research output: Contribution to journalArticlepeer-review


Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a "smart" default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year.

Original languageAmerican English
Article numbere81521
JournalPLoS ONE
Issue number12
StatePublished - 18 Dec 2013

All Science Journal Classification (ASJC) codes

  • General
  • General Biochemistry,Genetics and Molecular Biology
  • General Agricultural and Biological Sciences


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