Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior

Abstract

Health care consumers often make choices that are imperfectly informed and inconsistent with their expressed preferences. Past research suggests that these shortcomings become more pronounced as choices become more complex, through either additional options or more performance metrics. But it is unclear why this is true: Consumer choice remains a "black box" that research has scarcely illuminated. In this article, we identify four pathways through which complexity may impair consumer choice. We examine these pathways using data from an experiment in which consumers (hypothetically) selected a primary care physician. Some of the loss of decision quality accompanying more complex choice sets can be explained by consumers' skills and decision-making style, but even after accounting for these factors, complexity undermines the quality of decision making in ways that cannot be fully explained. We conclude by discussing implications for report designers, sponsors, and policy makers aspiring to promote consumer empowerment and health care quality.

Keywords: bounded rationality; choice; consumerism; decision styles; experiment; heuristics.

Figure 1

Possible choice pathways linking complex choice sets to impaired consumer choice.

Figure 2

Screenshot of performance overview page on SelectMD website: Arm 4.

Figure 3

Design for Select MD experiment. Note: CAHPS = Consumer Assessment of Healthcare Providers and Systems; HEDIS = Healthcare Effectiveness Data and Information Set.

Figure 4

Complexity of choice sets and quality of decision making.

Figure 5

Filtering choice sets and quality of decision making.

Figure 6

Excessively maximizing decision makers: Complexity and quality of decision making.