Psychological Aspects of Payer Decision-Making in Healthcare: Which Attitude Components Drive Decisions and How Can These Be Influenced?

OBJECTIVES: While payers usually have defined frameworks for assessment and decision-making, they often have to make final decisions while there is still much uncertainty. We explore whether there is evidence showing that other factors, such as psychological aspects, have an impact on healthcare payer decision-making.

METHODS: A targeted literature review on “psychology and payer decision-making in healthcare” was performed on 3rd May 2024 on PubMed. This was supplemented by a search on PubPsych for “payer decision making in healthcare,” and a grey search on Google.

RESULTS: The review returned fifty-five results from PUBMED, five from PubPsych, and ten from the supplemental search. Three studies were related directly to payer decision-making. The ABC model of attitudes was identified as an applicable and relevant structure comprising affective, behavioural and cognitive components to drive decision-making, where effects on cognition and behaviour can mitigate negative affective responses and ambivalence. Further data demonstrates that payers can better interpret risk scenarios when information is presented as an absolute rather than a relative risk. Payers may also revert to more anecdotal data or clinical opinion, where they may deem the existing evidence inadequate. They also have a slight preference for rewards with less delay. When making decisions under uncertainty, people prefer options they can remember better.

CONCLUSIONS: Alongside clear decision-making rules, the effective communication of relevant information appears crucial in supporting a payer’s decision based on cognition rather than ambivalence and affective reactions. Further research is needed to better understand the psychological aspects that may impact payer decision-making. The importance and relevance of such psychological components cannot be underestimated when it comes to reimbursement and coverage decisions.