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Effect of Assessment Method on the Discrepancy between Judgments of Health Disorders People have and do not have: A Web Study

Department of Psychology, University of Pennsylvania, Philadelphia, Leonard Davis Institute of Health Economics, University of Pennsylvania, baron{at}psych.upenn.edu

David A. Asch, MD, MBA

Leonard Davis Institute of Health Economics, University of Pennsylvania, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center

Angela Fagerlin, PhD

Veterans Administration Health Services Research and Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System and the Division of General Internal Medicine, University of Michigan, Program for Improving Health Care Decisions, Ann Arbor, Michigan

Christopher Jepson, PhD

Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia

George Loewenstein, PhD

Department of Social and Decision Sciences, Carnegie-Mellon University

Jason Riis, PhD

Department of Psychology, University of Michigan, Ann Arbor

Margaret G. Stineman, MD

Leonard Davis Institute of Health Economics, University of Pennsylvania, Department of Rehabilitation Medicine, University of Pennsylvania School of Medicine, Philadelphia

Peter A. Ubel, MD

Veterans Administration Health Services Research and Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System and the Division of General Internal Medicine, University of Michigan, Program for Improving Health Care Decisions, Ann Arbor, Michigan

Three experiments on the World Wide Web asked subjects to rate the severity of common health disorders such as acne or arthritis. People who had a disorder ("Haves") tended to rate it as less severe than people who did not have it ("Not-haves"). Two explanations of this Have versus Not-have discrepancy were rejected. By one account, people change their reference point when they rate a disorder that they have. More precise reference points would, on this account, reduce the discrepancy, but, if anything, the discrepancy was larger. By another account, people who do not have the disorder focus on attributes that are most affected by it, and the discrepancy should decrease when people make ratings on several attributes. Again, if anything, the discrepancy increased when ratings were on separate attributes (combined by a weighted average). The discrepancy varied in size and direction across disorders. Subjects also thought that they would be less affected than others.

Key Words: adaptation • utility assessment • response shift • focusing illusion

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