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Factors affecting Consumer Behaviour for the selection of Health Plan

Demographic Variables
The purpose of this study was an examination of how customers selected demographic
variables influence their healthcare purchasing decisions. In a review of such studies,
Thompson and Rao (1990) list the most prevalent variables: gender, marital status,
Religion/ethnicity, education, income level, age, geographical mobility, and family size. Since
their research, many additional studies have explored the relationships between demographic
variables and healthcare choice. The next several sections review current literature on the
selected demographic variables of gender, marital status, Religion/ethnicity, education,
income, and customers healthcare buying decisions. Most studies consider several variables
simultaneously. For clarity, discussion of the pertinent variables will be separated by section.
Gender
Gender is a primary variable in a number of studies that explore factors contributing to
healthcare choices. Siddharthan (1990) examined the effects of many demographic
variables on HMO enrollment in Dade County, Florida. Data by means of telephone surveys,
which requested over 200 pieces of information, were collected from of 1,438 U.S.-born and
foreign-born subjects. Multivariate analysis was performed with ANCOVA and logistic
regression equations. Of 10 variables tested (age, ethnicity, gender, employment, lifestyle,
physical access capabilities, native language, income, and doctor' s office visits), for U.S.born subjects, gender was found to be significant at the .10 level (B = 0.051) for choice of
healthcare plan. However, results also showed that for the total sample gender was not a
factor in subjects' deciding between alternate plans. Gender was also found more significant
in a study for HCFA by Rice, McCall, and Boismier (1991) on factors that affect Medicare
beneficiaries' choices of supplemental health insurance. Similarly, Wilcox-Gok and Rubin
(1994) studied Medicare enrollees' choices of private insurance. Surveys taken from the
Survey of Income and Program Participation for a total of 5,232 subjects age 65 and older
were examined.
Marital Status
Consistent with many previous studies, the second demographic characteristic studied in the
current review relating to the study purpose is marital status as a factor influencing their
healthcare purchasing decision. A number of previous studies have considered this factor.

Couples were focused on by Elbeck (1990) with regard to buying behavior in choosing
healthcare service. The purpose of the study was to determine the roles of spouses in
decisions toward recommendations for marketing of health services to the population. Two
hypotheses were formulated: (a) "Spouses will demonstrate little agreement to role
specialization variables when spouses are interviewed separately"; (b) "Joint role
specialization will predominate for health services decision making" .
Senior married couples were also studied by Hopper and Busbin (1995) for their choices of
healthcare insurance coverage and providers. The sample comprised a total of 84 retired
couples. Approximately one-third (35.1%) were 55 to 64 years old, the majority (54.2%) were
65 to 74, and the remainder (12.5%) were 75 to 84 years old. Six types of coverage were
examined: supplemental Medicare, cancer/intensive care, accident insurance, general health
and hospitalization coverage, HMO (Hospitals and Medical Officers), and preferred provider
organization (PPO).
Religion/ Ethnicity
Similar to other demographic variables, religion/ethnicity has been studied extensively in
relation to buying decisions. Siddharthan (1990) found in examining HMO enrollment by
Medicare beneficiaries in diverse communities that ethnic differences existed in seniors'
choice of Medicare HMO or fee-for-service plan. The sample comprised of several
ethnicities. The foreign-born subjects were distributed among many Hispanic ethnicities, with
Cuba reported as place of birth by more subjects than any other country. Almost 90% of those
surveyed were born outside the U.S. Of the sample, 45.1% were White non-Hispanic; 15.4%
were Black non-Hispanic; 34.8% were Hispanic; and 4.7% were others (including Asian and
Native American).
Complementary to these results regarding ethnicity are the findings of Rice et al. (1991) in
their study of factors affecting Medicare beneficiaries' choices of supplemental insurance.
On Wilcox-Gok and Rubin's (1994) four dependent variables (whether physicians were
visited, frequency of physician visits over 12 months, whether hospitals were stayed in,
frequency of days in hospital), it was found that being White increased the probability of
having supplemental health insurance. Multiple regressions showed that race was significant
on all four variables .
Education

As with the previous variables, many studies have analyzed education in conjunction with
other demographic factors in purchase decisions of healthcare plans. Siddharthan (1991b)
found that among the U.S.-born customers, education was non significant in whether
individuals purchased private insurance in addition to Medicare coverage. Among the foreignborn, however, Siddharthan found a significant correlation: those with a high school or lower
education had the lowest probability of purchasing private insurance.
Wilcox-Gok and Rubin (1994) arrived at similar results. In their study of four independent
variables (whether physicians were visited, frequency of physicians' visits over 12 months,
whether hospitals were stayed in, frequency of days in hospital), probit analysis revealed that
education was a significant factor.
Corroborating these results, in examining decisions on purchase of long-term care insurance,
Kumar et al. (1995) found that having a college education was significant for those holding
policies (p < .001). The researchers also found that a higher proportion of long-term care
policy owners were more college-educated than the general population.
Income
Income as a variable associated with purchase of healthcare plans has been studied as much
as or more than any other demographic variable. This may not be surprising because, as
Brunze (2002) notes, choice of health plan "is the single most important decision that a
consumer can make. Research shows that costs vary by up to 40%, between the most and
least efficient health plans in each market. Thus, it may be logical to assume that income is
an important factor in purchasing of healthcare plans.
Wilcox-Gok and Rubin (1994) did not differentiate among income levels in their exploration
of factors governing decisions to purchase supplemental insurance. However, their study
revealed similar results on four dependent variables concerning visits and frequency of visits
to physicians and hospitals.
The majority of studies reviewed examined several income levels of customers in relation to
healthcare insurance purchase. These studies also indicate that income is a strong factor in
healthcare insurance buying decisions. This chapter summarized literature on the theoretical
basis for this study, the demographic variables usedgender, marital status, religion/ethnicity,

education and income and their purchase of healthcare plans. As discussed above, most
studies over the last 12 years have amply demonstrated the significance of a range of
demographic variables in choice of healthcare plan.
Next chapter describes the methodology employed in this study. Included are the procedures
used to test the study variables and their relationships to decisions about their healthcare
purchase plans.

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