ABSTRACT
Introduction: To investigate how the provision of additional information about the health events and procedures covered by a healthcare plan affect the level of coverage chosen by young adults taking their first full time job. Methods: University students were recruited for a study at two behavioral laboratories (one located at the University of Toronto and the other located at INSEAD-Sorbonne University in Paris) in which they imagine they are making choices about the healthcare coverage associated with the taking a new job in Chicago, Illinois. Every participant made choices in four categories: Physician Care, Clinical Care, Hospital Care, and Dental Care. Participants were randomly assigned to one of two conditions: Low Detail or High Detail coverage information and they chose between three levels of coverage: Basic, Enhanced, and Superior. The study took place in March 2017 with 120 students in Toronto and 121 students in Paris. Results: The provision of more detailed information about the health events and procedures covered by a healthcare plan leads to a compromise effect in which participants shift their choices significantly towards Enhanced (moderate coverage) from Basic (low coverage) and Superior (high coverage). The compromise effect was observed at both locations; however, Paris participants choose significantly higher levels of coverage than Toronto participants. Discussion: Providing more detail to employees about the health events and procedures covered by a healthcare plan will increase the fraction of employees who choose the intermediate level of coverage. It is beyond the scope of this study to conclude whether this is good or bad; however, in a context where employees gravitate to either insufficient or excessive coverage, providing additional detail may reduce these tendencies.
ABSTRACT
AIMS AND OBJECTIVES: To explore patient decision delay, the symptom experience and factors that motivated the patient experiencing myocardial infarction to go to the emergency department. BACKGROUND: Reperfusion for myocardial infarction is more effective if performed as soon as possible after the onset of symptoms. Multiple studies show that prehospital delay is long and can average several hours. DESIGN: A qualitative descriptive design using semi-structured interviews. METHODS: All consecutive myocardial infarction patients who between July 2013-January 2014 at a single-centre metropolitan tertiary hospital in Western Australia were included. Patient responses to an open-ended question were recorded and transcribed verbatim. Data were analysed using Braun & Clarke (Qual Res Psychol, 3, 2006, 77-101) thematic analysis method. RESULTS: Of the 367 eligible, 255 provided consent. Three themes emerged from the qualitative analyses: (1) onset and response to symptoms, and this included three subthemes: context of the event, diversity of symptom interpretation and response to symptoms; (2) help-seeking behaviour, and this included the patient seeking help from various lay and professional sources; and (3) help-seeking outcomes, which include calling the emergency ambulance, going to emergency department, seeing a general practitioner, seeing a general practitioner who advised them to go home. CONCLUSION: The context of the event, their symptomatology and the layperson who was the first point of contact influenced the decision for the patient to go to the emergency department. Many patients used private transport or contacted their general practitioner. New knowledge from this study emphasises the importance of the layperson understanding the appropriate response is to seek prompt care through immediate emergency transport by ambulance to emergency department. RELEVANCE TO CLINICAL PRACTICE: This study highlights the need to educate both the patient and the wider public, not only to seek prompt care but to also to call the emergency ambulance to arrange transport to the emergency department.
