1. How Much Choice Do Seniors Want?: Survey Results on the Medicare Prescription Drug Benefit Janet Cummings Link* Thomas Rice* Yaniv Hanoch** *Department of Health Services, UCLA School of Public Health **Department of Psychology, University of Plymouth, England Funding: Robert Wood Johnson Foundation Investigator Award in Health Policy Research

2. Research Objective  To investigate whether seniors prefer a large number of Medicare drug plan choices versus a handful of plans to choose from  To examine the determinants of these beliefs (demographics, SES, health status, political party, and political ideation)

3.  Passage of Medicare Part D resulted in a stand-alone insurance policy  In 2007, more than 50 plans available in all of the contiguous 48 states  Is this too much choice for seniors to navigate? Background and Significance

4.  Theory from economics and psychology posits that more choice benefits consumers with the following assumptions:  Sufficient information about choices  Consumers can sift through choices  Consumers will not regret choices NOT made  Consumers do not dwell on what others have  Newer research suggests that too much choice can have adverse consequences  Seniors may be especially prone to adverse effects of too much choice Background and Significance

5.  Seniors with greater cognitive abilities and resources will prefer more choice  Younger seniors will prefer more choice  Higher Education and Income will be associated with preference for more choice  Political party affiliation and political ideology will be associated with preference for choice  Republicans will prefer more choice relative to Democrats and Independents  Conservatives will prefer more choice relative to Liberals and Moderates Hypotheses

6.  Nationally representative survey of 718 seniors conducted in November 2006  Survey conducted jointly by the Kaiser Family Foundation and Harvard School of Public Health Data

7. 718 seniors interviewed 653 seniors without missing information for dependent variable 628 seniors without missing information for key explanatory variables Analytic deletions 65 who responded “Don’t know” or “Refused” for outcome variable 25 observations missing on one or more of the following: Age, marital status, self-rated health, education, race Analytic Sample

8.  Dependent Variable (Dichotomous) Which statement better reflects your opinion: Medicare should offer seniors dozens of drug plans so individuals can select their own plan to meet their needs OR Medicare should select a handful of drug plans that meet certain standards, to make it easier for seniors to pick among those plans Variables

9.  Explanatory Variables Demographics: Age (indicator for 75+), Gender, Marital status Race/Ethnicity (White, Black, Other), Socioeconomic Status: Education, Income Health Status: Self-rated health (indicator for fair/poor), Indicator for whether Senior takes medication Region and Urban Status Political Party: Republican, Democrat, Independent, Other Political Ideology: Conservative, Liberal, Moderate, Unknown Variables

10. Descriptive Statistics for Analytic Sample Proportion Prefer Dozens of Plans31.5% Prefer Handful of Plans68.5% Female 57.3% White 88.4% High school degree or less 40.9% Income less than $40,000 51.4% Self-reported health fair/poor 20.4% Take medication 86.6%

11. Key Results From Logistic Regression VariableOdds Ratio95% Conf. Interval Age0.740.51, 1.07 Black 2.60**1.15, 5.90 Other1.370.69, 2.72 High School Graduate 0.47**0.25, 0.86 Some College0.800.43, 1.47 College Graduate 0.52**0.27, 0.99 Liberal 0.62*0.36, 1.08 Moderate 0.64**0.42, 0.97 Views unknown0.530.17, 1.66 Outcome Variable: Prefer dozens of plans (vs. prefer handful) *p<0.10, **p<0.05

12.  Maintain the status quo  Reduce the number of drug plan choices offered to seniors  Standardize drug plans Policy Implications