Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Anthony DeFulio

Second Advisor

Dr. Scott T. Gaynor

Third Advisor

Dr. Cynthia J. Pietras

Fourth Advisor

Dr. Warren K. Bickel


Intertemporal choice, healthcare, discounting, decision-making, cost


While the United States has some of the highest healthcare spending in the world, it has some of the worst health outcomes. For example, maternal mortality in the United States is almost five times as high as in other similarly wealthy countries. It also has the highest rates of avoidable deaths. One of the reasons for this may be the cost of accessing healthcare due to privatized insurance. For example, Americans may avoid important preventive medical visits and other health screeners due to cost. While lack of health insurance has been correlated with decreased health utilization, a precise understanding of the determinants of care seeking has not been established. Modeling healthcare use based on common symptoms (e.g., cough, headache, nausea) can provide insight on how Americans may seek care for symptoms that could be indicative of more serious health problems. Modeling of decision-making can be accomplished through methods used in behavioral economics, most notably methods for studying intertemporal choice. Therefore, the purpose of present study was to apply behavioral economic methodologies to better understand healthcare utilization based on symptom, severity, and cost. Three experimental surveys each consisting of 200 participants recruited from Amazon Mechanical Turk were conducted. The first experimental survey consisted of monetary discounting of delayed or probabilistic rewards and losses as well as medical decision-making for seeking a medical professional based on symptom (i.e., cough, headache, nausea) and severity (i.e., mild, moderate, severe). With regard to monetary discounting, data replicated typical monetary discounting research. The gain/loss changes in discounting occurred for delayed and probabilistic outcomes. With regard to health decision-making, as severity of symptom and duration of symptom experienced increased, so did likelihood to seek a healthcare professional. When cost was added as a factor in Experiments 2 and 3, increased costs decreased likelihood to seek a healthcare professional. Generally, models used in monetary discounting fit participant data well. When possible to assess the relationship between impulsivity, riskiness, and health decision-making, there was a positive relationship between seeking medical help and impulsivity. That is, those that were “more impulsive” based on monetary discounting were more likely to seek a healthcare professional for symptoms sooner. There was no relationship between impulsivity and riskiness as determined by monetary discounting, nor was riskiness related to health decision-making. For demographic variables, better health decreased the likelihood of seeing health professional, as well as for those who reported previously avoiding or delaying going to a doctor due to cost. The implications of these results are straightforward, in that associating a cost with healthcare will decrease the likelihood an individual will seek medical treatment at all levels of symptom severity. This study adds to growing body of data that the American medical system is in need of substantial reform if the goal is to keep all Americans healthy, rather than only those Americans who can afford it.

Access Setting

Dissertation-Open Access