Appendix Table 1. Additional Participant Characteristics

Appendix Table 1. Additional Participant Characteristics

All Participants
(n=1001), % / Altruism Group
(n=497), % / Control Group
(n=504), % / P Value
Marital Status / 0.934
Married / 58.9 / 59.2 / 58.7
Widowed / 2.7 / 2.8 / 2.6
Divorced / 6.4 / 7.0 / 5.8
Separated / 1.2 / 1.2 / 1.2
Never married / 21.4 / 20.9 / 21.8
Living with partner / 8.2 / 7.4 / 8.9
Prefer not to answer / 1.2 / 1.4 / 1.0
Education Level / 0.881
High school or less / 11.7 / 12.3 / 11.1
Some college/associate's degree / 30.2 / 29.4 / 31.0
College graduate / 35.3 / 36.0 / 34.5
Graduate/professional school / 22.6 / 21.9 / 23.2
Prefer not to answer / 0.3 / 0.4 / 0.2
Household Income / 0.134
Less than $50,000 / 16.3 / 17.3 / 15.3
$50,000 to $74,999 / 10.3 / 10.5 / 10.1
$75,000 to $99,999 / 13.9 / 14.9 / 12.9
$100,000 + / 54.2 / 50.7 / 57.7
Prefer not to answer / 5.3 / 6.6 / 4.0
Political Affiliation / 0.883
Republican / 28.0 / 29.4 / 26.6
Democrat / 33.9 / 33.2 / 34.5
Independent / 22.0 / 21.7 / 22.2
Other / 2.3 / 2.4 / 2.2
No Preference / 13.9 / 13.3 / 14.5
Political Ideology / 0.037
Liberal / 31.8 / 29.4 / 34.1
Moderate, middle of the road / 32.7 / 31.2 / 34.1
Conservative / 35.6 / 39.4 / 31.7
Health Insurance / 0.356
Private, employer-sponsored / 58.6 / 56.3 / 60.9
Private, exchange / 6.2 / 5.0 / 7.3
Private, direct / 6.5 / 7.2 / 5.8
Medicaid / 5.2 / 5.6 / 4.8
Medicare / 14.0 / 15.3 / 12.7
Other / 3.1 / 3.2 / 3.0
None / 6.4 / 7.2 / 5.6

Appendix Table 2. Association of participant characteristics with their requests for overused health services

Adjusted Odds Ratio / 95% CI / P value
Age
18 – 34 / ref
35 – 44 / 0.94 / 0.70 / 1.27 / 0.679
45 – 54 / 0.99 / 0.75 / 1.31 / 0.954
55 – 64 / 0.72 / 0.54 / 0.95 / 0.018
65 + / 0.72 / 0.54 / 0.95 / 0.020
Sex
Female / 0.91 / 0.76 / 1.10 / 0.342
Race/Ethnicity
Non-Hispanic White / ref
African American / 1.26 / 0.93 / 1.71 / 0.138
Hispanic / 1.77 / 1.35 / 2.32 / <0.001
Other/multiracial / 0.86 / 0.62 / 1.21 / 0.395
Region
Northeast / ref
South / 1.02 / 0.78 / 1.33 / 0.891
West / 0.94 / 0.70 / 1.25 / 0.660
Midwest / 1.07 / 0.81 / 1.43 / 0.624
Education Level
High school or less / ref
Some college/associate's degree / 0.78 / 0.56 / 1.10 / 0.152
College graduate / 0.79 / 0.57 / 1.11 / 0.176
Graduate/professional school / 0.60 / 0.41 / 0.85 / 0.005
Household Income
Less than $50,000 / ref
$50,000 to $74,999 / 0.95 / 0.65 / 1.39 / 0.808
$75,000 to $99,999 / 1.05 / 0.74 / 1.50 / 0.785
$100,000 + / 0.79 / 0.58 / 1.07 / 0.133
Self-Reported Health Status
Excellent / ref
Very good / 0.83 / 0.64 / 1.07 / 0.142
Good / 0.80 / 0.61 / 1.04 / 0.101
Fair / 0.82 / 0.55 / 1.21 / 0.323
Poor / 0.84 / 0.33 / 2.14 / 0.715
Prior Receipt of Medical Service
No / ref
Yes / 3.16 / 2.65 / 3.77 / <0.001
Altruistic Value Score / 0.97 / 0.93 / 1.00 / 0.075
Marital Status
Married / ref
Widowed / 1.07 / 0.64 / 1.80 / 0.790
Divorced / 1.12 / 0.74 / 1.69 / 0.595
Separated / 3.73 / 1.26 / 11.07 / 0.018
Never married / 1.29 / 0.97 / 1.70 / 0.077
Living with partner / 1.01 / 0.72 / 1.42 / 0.945

Appendix Table 2, continued. Association of participant characteristics with their requests for overused health services

Adjusted Odds Ratio / 95% CI / P value
Political Affiliation
Republican / ref
Democrat / 0.81 / 0.63 / 1.05 / 0.110
Independent / 0.79 / 0.61 / 1.02 / 0.067
Other / 0.73 / 0.40 / 1.33 / 0.298
No Preference / 0.68 / 0.49 / 0.95 / 0.022
Political Ideology
Liberal / ref
Moderate, middle of the road / 1.15 / 0.92 / 1.45 / 0.221
Conservative / 1.22 / 0.97 / 1.54 / 0.093
Health Insurance
Private, employer-sponsored / ref
Private, exchange / 0.98 / 0.66 / 1.45 / 0.916
Private, direct / 1.28 / 0.89 / 1.86 / 0.188
Medicaid / 1.93 / 1.20 / 3.12 / 0.007
Medicare / 1.38 / 0.92 / 2.05 / 0.116
Other / 0.86 / 0.52 / 1.41 / 0.546
None / 1.30 / 0.86 / 1.98 / 0.217
Cost Attitudes
Health care costs are a major
Problem / 0.89 / 0.52 / 1.51 / 0.658
Patients should help control
health care costs / 0.51 / 0.41 / 0.63 / <0.001
It is ok for doctors to
recommend against services
that are unlikely to be beneficial / 0.55 / 0.43 / 0.71 / <0.001
I can help reduce health care
Costs / 0.67 / 0.53 / 0.85 / 0.001

Adjusted logistic regression models include participant characteristic, clinical scenario, randomization group, age, gender, and race/ethnicity

Appendix Table 3. Association of participant characteristics with their rating of physicians

Adjusted Difference / 95% CI / P value
Age
18 – 34 / ref
35 – 44 / -0.06 / -0.42 / 0.29 / 0.730
45 – 54 / 0.02 / -0.34 / 0.38 / 0.910
55 – 64 / 0.12 / -0.27 / 0.51 / 0.542
65 + / 0.21 / -0.18 / 0.60 / 0.296
Sex
Female / 0.16 / -0.09 / 0.40 / 0.210
Race/Ethnicity
Non-Hispanic White / ref
African American / 0.36 / -0.06 / 0.78 / 0.093
Hispanic / 0.18 / -0.19 / 0.56 / 0.337
Other/multiracial / 0.19 / -0.24 / 0.62 / 0.383
Region
Northeast / ref
South / 0.10 / -0.26 / 0.47 / 0.589
West / 0.02 / -0.37 / 0.40 / 0.936
Midwest / 0.06 / -0.33 / 0.45 / 0.779
Education Level
High school or less / ref
Some college/associate's degree / -0.26 / -0.71 / 0.19 / 0.258
College graduate / -0.06 / -0.50 / 0.38 / 0.797
Graduate/professional school / 0.11 / -0.39 / 0.60 / 0.666
Household Income
Less than $50,000 / ref
$50,000 to $74,999 / -0.09 / -0.58 / 0.41 / 0.733
$75,000 to $99,999 / 0.06 / -0.42 / 0.54 / 0.799
$100,000 + / 0.15 / -0.25 / 0.55 / 0.452
Self-Reported Health Status
Excellent / ref
Very good / -0.38 / -0.74 / -0.03 / 0.035
Good / -0.31 / -0.68 / 0.06 / 0.097
Fair / -0.30 / -0.86 / 0.26 / 0.298
Poor / -0.98 / -2.03 / 0.08 / 0.071
Prior Receipt of Medical Service
No / ref
Yes / -0.01 / -0.22 / 0.20 / 0.920
Altruistic Value Score / 0.07 / 0.02 / 0.12 / 0.004
Marital Status
Married / ref
Widowed / -1.21 / -2.07 / -0.34 / 0.006
Divorced / -0.51 / -1.09 / 0.06 / 0.081
Separated / -0.61 / -1.95 / 0.74 / 0.378
Never married / -0.30 / -0.65 / 0.04 / 0.082
Living with partner / -0.24 / -0.67 / 0.19 / 0.279

Appendix Table 3, continued. Association of participant characteristics with their rating of physicians

Adjusted Difference / 95% CI / P value
Political Affiliation
Republican / ref
Democrat / 0.08 / -0.26 / 0.41 / 0.649
Independent / 0.08 / -0.26 / 0.42 / 0.637
Other / 0.52 / -0.21 / 1.25 / 0.160
No Preference / -0.45 / -0.88 / -0.02 / 0.041
Political Ideology
Liberal
Moderate, middle of the road / -0.24 / -0.53 / 0.06 / 0.121
Conservative / -0.46 / -0.78 / -0.15 / 0.004
Health Insurance
Private, employer-sponsored / ref
Private, exchange / 0.49 / -0.03 / 1.02 / 0.066
Private, direct / 0.22 / -0.28 / 0.72 / 0.393
Medicaid / 0.30 / -0.23 / 0.83 / 0.263
Medicare / 0.79 / 0.27 / 1.31 / 0.003
Other / -0.05 / -0.76 / 0.65 / 0.884
None / -0.25 / -0.80 / 0.31 / 0.385
Cost Attitudes
Health care costs are a major
problem / 0.66 / -0.10 / 1.42 / 0.090
Patients should help control
health care costs / 0.79 / 0.49 / 1.10 / <0.001
It is ok for doctors to
recommend against services
that are unlikely to be beneficial / 1.02 / 0.69 / 1.35 / <0.001
I can help reduce health care
costs / 1.09 / 0.78 / 1.40 / <0.001

Adjusted linear regression model includes participant characteristic, clinical scenario, randomization group, age, gender, and race/ethnicity

Full Text of Survey Vignette: Imaging for Acute Low Back Pain

Imagine that you develop sudden back pain while working in your yard. You are in a lot of pain, and the pain occasionally shoots down one of your legs. You try over-the-counter pain medicines and applying ice, both of which help the pain a little bit. After 2 days without much improvement, you decide to see a doctor.

After the doctor examines you, she reassures you that you probably pulled a muscle in your back and should recover in a few weeks. Rarely, the pain can be due to more serious injury, such as a “herniated disc” (also known as a “slipped disc”), which could require surgery. However, even those more serious injuries can improve in a few weeks without surgery. She recommends continuing to use the over-the-counter pain medicines and refers you to physical therapy.

The doctor says that a lot of patients with back pain ask about imaging tests (such as an X-ray or MRI). She reassures you that imaging tests at this stage are unlikely to have much benefit. In fact, patients who receive imaging tests are more likely to have unnecessary surgery.

[Randomization: (A) blank; or (B) “Additionally, she says that not ordering the test now will help keep health care costs down. Saving money will reduce the cost of health insurance and will help other people afford the care they need.”]

However, the doctor says that if you want to have an imaging test done now, your insurance will cover it (with a small copayment), and ultimately the decision is yours.

Question: Do you think that you are going to ask that the doctor order an imaging test now?

Definitely Yes

Probably Yes

Probably No

Definitely No

Question: Using any number from 0 to 10, where 0 is the worst doctor possible and 10 is the best doctor possible, what number would you use to rate this doctor?

Worst doctor possibleBest doctor possible

012345678910

Full Text of Survey Vignette: Annual Exams for Healthy Adults

Imagine that you are generally healthy. You have seen a primary care doctor each year for the last few years. At these visits, the doctor examines you and draws blood for routine tests. She usually recommends ways you can improve your diet, exercise, and sleep, but has never diagnosed any problems or recommended any medications. These “annual exams” are free with your insurance.

At this year’s visit, the doctor suggests that you don’t need to continue having annual exams since you have been healthy. She recommends that you can schedule an appointment if you develop any new symptoms that concern you, such as a cough, headaches, or joint pain.

The doctor reassures you that there are not any long-term benefits from annual exams. In fact, there may even be a small risk of harm, such as if an invasive procedure is used to follow-up an abnormal blood test that was never actually a problem.

[Randomization: (A) blank; or (B) “Additionally, she says that there are too few primary care doctors in your community, so other people are having a hard time finding a doctor for needed care. Forgoing an annual exam will help increase access to primary care doctors and will help others in your community.”]

However, the doctor says that if you want to continue having annual exams, your insurance will cover them, and ultimately the decision is yours.