Why Do People Decline Free Preventive Health Care?

Posted: 17 Jun 2007

See all articles by Katherine Grace Carman

Katherine Grace Carman

RAND Corporation

Peter Kooreman

Tilburg University - Center and Faculty of Economics and Business Administration; IZA Institute of Labor Economics

Date Written: June 2007


For many health conditions, the best treatment is prevention. To this end, many countries and insurers around the world encourage individuals to participate in preventive care. Citizens in the Netherlands are offered several preventive health care interventions free of charge, including flu shots, mammograms, and kidney checks. Despite little to no direct costs to the patient, many people fail to participate in these programs. The aim of this paper is to explain participation. Our primary data source is the CentERpanel, which contains rich information on socioeconomic variables, as well as (in an extra module) on health status and the use of preventive health care. The CentERpanel includes over 2000 Dutch households who participate in weekly internet surveys.

Similar to other future investments, there are many reasons why people may not participate in these programs. While for some people it is likely to be rational not to participate, many individuals who should rationally participate actually do not. However, myopia, cognitive biases and lack of information or understanding about the costs and benefits of these programs, may lead others to irrationally choose not to participate. Additionally, fear of unfavorable diagnoses, particularly cancer, often leads people to decline screening or medical treatment altogether. In vaccination programs, controversy about the effectiveness and possible negative side effects may play a role in the participation decision.

We empirically assess the importance of these different explanations, and investigate how they relate to socioeconomic characteristics of individuals and social interactions. We also consider the relationship with forward-looking choices such as savings and insurance, which may serve as indicator of individuals' discount rates. The paper contributes to a fuller understanding of participation decisions in preventive health care and to creating more effective preventive care programs in the future.

Keywords: Preventive Care

JEL Classification: D81, I12

Suggested Citation

Carman, Katherine Grace and Kooreman, Peter, Why Do People Decline Free Preventive Health Care? (June 2007). iHEA 2007 6th World Congress: Explorations in Health Economics Paper. Available at SSRN: https://ssrn.com/abstract=994181

Katherine Grace Carman (Contact Author)

RAND Corporation ( email )

1776 Main Street
P.O. Box 2138
Santa Monica, CA 90407-2138
United States

Peter Kooreman

Tilburg University - Center and Faculty of Economics and Business Administration ( email )

P.O. Box 90153
Tilburg, 5000 LE

HOME PAGE: http://www.peterkooreman.nl

IZA Institute of Labor Economics

P.O. Box 7240
Bonn, D-53072

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