Lutter Johanna I, Szentes Boglárka, Wacker Margarethe E, Winter Joachim, Wichert Sebastian, Peters Annette, Holle Rolf, Leidl Reiner
Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764, Neuherberg, Germany.
Ludwig-Maximilians-Universität München, Institute for Medical Informatics, Biometry and Epidemiology, Marchioninistr 15, 81377, Munich, Germany.
Health Econ Rev. 2019 Aug 30;9(1):26. doi: 10.1186/s13561-019-0243-9.
Risk attitudes influence decisions made under uncertainty. This paper investigates the association of risk attitudes with the utilization of preventive and general healthcare services, work absence and resulting costs to explore their contribution to the heterogeneity in utilization.
Data of 1823 individuals (56.5 ± 9.5 years), participating in the German KORA FF4 population-based cohort study (2013/2014) were analyzed. Individuals' general and health risk attitude were measured as willingness to take risk (WTTR) on 11-point scales. Utilization of preventive and medical services and work absence was assessed and annual costs were calculated from a societal perspective. Generalized linear models with log-link function (logistic, negative-binomial and gamma regression) adjusted for age, sex, and height were used to analyze the association of WTTR with the utilizations and costs.
Higher WTTR was significantly associated with lower healthcare utilization (physician visits, physical therapy, and medication intake), work absence days and indirect costs. Regarding preventive services, an overall negative correlation between WTTR and utilization was examined but this observation remained non-significant except for the outcome medical check-up. Here, higher WTTR was significantly associated with a lower probability of participation. For all associations mentioned, Odds Ratios ranged between 0.90 and 0.79, with p < 0.05. Comparing the two risk attitudes (general and regarding health) we obtained similar results regarding the directions of associations.
We conclude that variations in risk attitudes contribute to the heterogeneity of healthcare utilization. Thus, knowledge of their associations with utilization might help to better understand individual decision-making - especially in case of participation in preventive services.
风险态度会影响在不确定性情况下做出的决策。本文研究风险态度与预防性和常规医疗服务利用、缺勤情况以及由此产生的成本之间的关联，以探讨它们对利用情况异质性的影响。
对参与德国KORA FF4基于人群的队列研究（2013/2014年）的1823名个体（年龄56.5±9.5岁）的数据进行分析。个体的一般风险态度和健康风险态度通过在11分制量表上的冒险意愿（WTTR）来衡量。评估预防性和医疗服务的利用情况以及缺勤情况，并从社会角度计算年度成本。使用具有对数链接函数的广义线性模型（逻辑回归、负二项回归和伽马回归），并对年龄、性别和身高进行调整，以分析WTTR与利用情况和成本之间的关联。
较高的WTTR与较低的医疗服务利用（就诊、物理治疗和药物摄入）、缺勤天数和间接成本显著相关。关于预防性服务，研究了WTTR与利用情况之间的总体负相关，但除了体检结果外，这一观察结果仍不显著。在此，较高的WTTR与较低的参与概率显著相关。对于所有提及的关联，优势比在0.90至0.79之间，p<0.05。比较两种风险态度（一般风险态度和健康风险态度），我们在关联方向上得到了类似的结果。
我们得出结论，风险态度的差异导致了医疗服务利用的异质性。因此，了解它们与利用情况的关联可能有助于更好地理解个体决策——尤其是在参与预防性服务的情况下。
