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अमूर्त

The Role of Prospect Theory in Screening Behavior Decision-Making in a Health-Insured Population of South Africa

Leegale Adonis, Debashis Basu and Prof John Luiz

Background: Prospect theory suggests that people avoid risks when faced with the benefits of a decision but take risks when faced with the costs of a decision. Screening for diseases can be defined as a ‘risk’, in the context of uncertainty. The outcome can either be a ‘benefit’ of good health or a ‘cost’ of ill health or poor-quality health.

Purpose: To assess whether prospect theory can predict screening behavior in the context of a chronic disease diagnosis as well as the exposure to incentives to screen.

Methods: A retrospective longitudinal case-control study for the period 2008-2011 was conducted using a random 1% sample of 170,471 health-insured members, assessing screening for cancers, chronic diseases of lifestyle and HIV, some of whom voluntarily join an incentivized wellness program.

Results: Individuals diagnosed with a chronic disease screened up to 9.0% less for some diseases over time. Mammogram screening however increased (p<0.001). Where a family member was diagnosed with a chronic disease, individual screening decreased up to 8.6%. Similarly females in families where a member was diagnosed with a chronic disease screened more for breast cancer (p<0.001). Males were more sensitive to incentives only for HIV screening (p<0.001), while the female responses to incentives were inconsistent.

Conclusion: A chronic disease diagnosis or the risk of developing a chronic disease resulted in reduced future screening behavior for most diseases. The role of incentives was inconsistent. Prospect theory adequately predicts screening behavior when diagnosed or faced with a possible chronic disease diagnosis for most screening tests except for females screening for breast cancer.