HI Family Decision Making

Topic

Family Decision Making Pattern and Framework for Health

Insurance

Authors

Mr. Sujit Kumar Patra Ms. Chunku Pani

Asst. Professor Asst. Professor

Institute of management & Information Institute of management & Information

Science (IMIS) Science (IMIS)

Email Id- [email protected] Email Id- [email protected]

[email protected] [email protected]

Mobile No. – 9583312434 Mobile No.- 9937022278

Mailing Address- Swagat Vihar Mailing Address- Swagat Vihar

Bankuala Bankuala

Bhubaneswar-751002 Bhubaneswar-751002

mailto:[email protected]




Family Decision Making Pattern and Framework for Health Insurance

Sujit Kumar Patra1 Chunku Pani2

Abstract

Families constitute an important economic and social unit that affects consumption decisions

of individual family members. Of all the reference groups, family has one of the strongest,

immediate, and most pervasive effects on consumer's psyche.

The family’s decision-making process has been studied by researchers for years. Although

the knowledge has increased substantially on this topic, research has generally focused on

goods. Since services continue to dominate Indian GDP and Insurance plays a very dominant

role in increasing the GDP, understanding the behavior of the family while buying health

insurance becomes critical.

Family decision-making research has frequently examined role relationship between husband

and wife across stages and sub-decisions. In this study it is being tried to find out, the role

played by parents and children other than husband and wife in family decision-making

process and how does a family decide on a financial product such as a Health Insurance

Product.

Keywords: Family decision making, Health Insurance, Family Role, Decision making,

Consumer Behavior

2

Introduction

The family has been identified as the most essential decision making and consumption unit

(Assael, 1998). Therefore the realm has attracted the interest of marketers and marketing

academicians over the years (e.g., Kim and Lee, 1997; Moore et al., 2002; Shoham &

Dalakas, 2005). For many consumer purchase decisions, it is the family rather than the

individual that is the critical decision making and consumption unit. This idea has been

recognized by researchers for some time: joint decision-making has been reported in the

areas of home purchasing (Cunningham and Green 1974; Davis and Rigaux 1974;

Munsinger, Weber, and Hasen 1975), automobile purchasing, and home furnishings (Davis

1970;Green and Cunningham 1975).

“Decision-making” describes the process by which families make choices, judgments, and

ultimately come to conclusions that guide behaviors. Family decision-making entails that

more than one member’s input and accord is involved (Scanzoni & Polonko 1980).

The decision-making process is centered on core communication processes involved in

creating shared meaning. In the decision-making process, families can accept the differences

among members and confer their needs for imminence and independence (Baxter &

Montgomery 1996). Davis has identified various stages in the decision-making process and

the relative amount of influence each of the family members has in these stages (Davis 1970,

1971; Davis and Rigaux 1974). Others have also considered the differences in perceived

influence of the husband and wife (Ferber and Lee 1974; Filatrault and Ritchie 1980). Haley,

Overholser, and Associates (1975) measured both the direct and indirect (taking the

husband’s wife’s preference into consideration) influence of the husband and wife in the

purchase of 87 packaged products. Other studies have begun to consider the determinants of

role structure, such as empathy and involvement (Burns 1977; Bums and Granbois 1977).

According to Shets (1974), joint decision making is more likely in the following situations: 1)

when the level of perceived risk in buying is high, 2) when the purchasing decision is more

important to the family, 3) when there are few time pressures, and 4) for certain demographic

3

groups (e.g. upper and lower socio economic groups, younger families, those with no

children, and those with only one of the parents working).

Decisions within families can be classified into types such as: instrumental, affective, Socio-

economic, and technical. Instrumental decisions are those that focus on issues of money,

health, shelter, and food for the family members (Epstein et al. 1982).

Family members play a variety of roles in decision-making. There are five roles that could be

played by the members of the family. In any given situation, the same member may take on

several or even all five roles (Assael 1992): The information gatherer (gatekeeper), the

influencer, the decision maker, the purchasing agent, and the end consumer.

These studies have been very important in developing a basic understanding of family buying

patterns. However, as suggested by Davis (1976), most past studies have focused only on the

outcomes of the decision-making process, rather than on the process itself. The result is that

very little is known about how families reach decisions.

Influence of children

Research on family decision making has been largely confined to spouses, who have been

considered as the relevant decision making unit in a family. However, the role of third party

influences, such as children, on decision making strategies and negotiations is essential to

taking a broader view of the relevant unit of analysis. Conventionally, women were seen to

be the purchasing agents for the family. Nevertheless, increasing participation of women in

the workforce has prompted a shift in this role as children are increasingly the “buyers” for

the entire family. Even in families where women do not work, children are observed to share

this role with their mothers. Children enjoy greater prudence not only in making everyday

consumption decisions for the family but also in influencing their parents to buy other

products desired by them. The temperament and disposition of each child can greatly vary

within the same family. Foxman et al. (1989) concluded that children tend to have more

“say” in the purchase of products that are less expensive and for their own use.

Contemporary researchers express that children constitute a major consumer market, with

direct purchasing power for snacks and sweets, and indirect purchase influence while

shopping for big-ticket items (Halan, 2002; Singh, 1998). Consequently, the relationship

between parents and different siblings is dynamic and unique, with each individual

responding to and modifying the behavior of the other (e.g., Pecchioni et al. 2005). Geuens et

al. (2002) observed that the relative influence of children varies by the extent to which the

parents are busy.

4

Indian children have recently attracted substantial attention from marketers because the

market for children’s products offers fabulous potential (pegged at Rs. 5000 crore/$1110mn)

and is rapidly growing. According to available industry data, 54% of India is estimated to be

under the age of 25 (Bansal, 2004).

Family Decision Making in India

According to Webster (2000), “India is an interesting culture in which to explore the

antecedents of marital power because its social and intellectual grains operate in ways vastly

different from those the West takes for granted. For instance, unlike western culture, where

the nuclear and neo local families are both the ideological and factual norm, the joint family

has been and continues to be an important element of Indian culture.”

Family Decision Stages

Just as there are different purchase roles, there are also a number of different steps in the

decision to buy a product or service. And the amount of influence exerted by the husband,

wife and children will vary, depending on the stage of the decision process.

Following is the five-stage decision-making model which includes:

1. Problem recognition

2. Search for information

3. Evaluation of alternatives

4. Final decision

5. Purchase

The role of husband, wife and children will differ across the stages. There can thus be shifts

in the husband-wife decision-making from stage one of problem recognition, to stage two of

search for information and finally, to the decision. Marketers should therefore examine

husband-wife decision-making in terms of specific purchase factors.

Health Insurance Family Decision Making

Jennifer Schultz, Roger Feldman & Jon Christianson et al. (2002) has evaluated the health

insurance choices of families enrolled in a direct contracting model developed by an

employer purchasing alliance.

5

Families are often uniquely qualified in terms of understanding patient attitudes and decision

making strategies and can therefore assist as an important resource in helping the patient to

make better decisions about their care (Blustein 1998).

Families make decisions about health issues using information from a variety of sources,

including insurance provider lists, internet research, recommendations from primary care

physicians and specialists, interpersonal communication with friends and family members,

and mediated messages (see Pecchioni & Sparks 2007).

The decisions made by families involve large amounts of money and, it is necessary to

understand as much as possible about this consumption unit. In this section we will examine

how families make their purchase decision. How many members are involved in each

decision? How are they involved? How does this influence work on the outcome? What is the

best way to reach them?

As in other small groups, there is a well defined role structure in families as well, as you

would find if you apply this concept to your own family. Thus, there is the Instrumental role,

usually taken by the head of the family for the achievement of specific goals. In addition,

there is the expressive role undertaken by the wife and other family members to provide

emotional support to the functioning of the family group. In addition to this goal-oriented

behavior there is also a set of purchase roles undertaken by family members.

Emerging health insurance market

Health insurance in a narrow sense would be ‘an individual or group purchasing health care

coverage in advance by paying a fee called premium.’ In its broader sense, it would be any

arrangement that helps to defer, delay, reduce or altogether avoid payment for health care

incurred by individuals and households. Given the appropriateness of this definition in the

Indian context, this is the definition, we would adopt. The health insurance market in

India is very limited covering about 10% of the total population. The existing schemes can be

categorized as:

(1) Voluntary health insurance schemes or private-for-profit schemes;

(2) Employer-based schemes;

(3) Insurance offered by NGOs / community based health insurance, and

(4) Mandatory health insurance schemes or government run schemes (namely ESIS, CGHS).

6

In recent years, there has been a liberalization of the Indian healthcare sector to allow for a

much-needed private insurance market to emerge. Due to liberalization and a growing middle

class with increased spending power, there has been an increase in the number of insurance

policies issued in the country. In 2001-02, 7.5 million policies were sold. By 2003-04, the

number of policies issued had increased by 37%, to 10.3 million.

Still, it is quite disheartening to find that Insurance is limited to only a small proportion of

people in the organized sector covering less than 10% of the total population. Currently, there

is no mechanism or infrastructure for collecting mandatory premium among the large

informal sector. Even in terms of the existing schemes, there is insufficient and inadequate

information about the various schemes. Data gaps also prevail. Much of the focus of the

existing schemes is on hospital expenses. There continues to be lack of awareness among

people about health insurance. Hence, this study was made to find out how a family as a

buying unit behaves while purchasing a Health Insurance product.

Importance of the study:

Families are more complex to understand as compared to individual consumers for specific

roles played by family members undergo dynamic and continuous changes because of

psychographic and attitudinal metamorphosis. Some families remain essentially traditional in

their life styles following the traditional role patterns and relationships, while others adopt

more materialistic orientations; wherein the individual family member becomes of prime

importance because of his individuality. In such families, the choice of each individual needs

to be considered independently and every individual priority owes due consideration before

the final decision outcome. Still, some other families are left in between-trying to adopt the

modern life style and at the same time confining to the traditional norms and values. The

roles and relationships in such families follow an entirely different pattern. These shifts are

also being increasingly caused by participation of women in the labor force. The dual-career

families, within a social stratum, have relatively greater discretionary income to buy products

that are otherwise sometimes out of reach, for single-earner families. Not only are the buying

structures different, but also the persons involved in the purchase and use of these products

differ due to various factors playing in the family, one of which is the time pressure

experienced by women in such families.

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Such a study is important for the marketers, as in the current business scenario, the choice of

which health insurance to purchase has become crucial in the Indian economy, especially

since today it is a service driven one.

Objectives of the study:

The authors had the following objectives for this study:

To understand the family’s decision making process.

To identify the factors those contribute to the family’s decision making process

while buying health insurance.

To attempt to provide a framework of buying behavior among Indian families

while purchasing health insurance.

In order to fulfill their first objectives, the authors have framed 3 Hypothesis for their study.

Hypothesis

H01: There is an association between family and health Insurance purchase Initiation

H11: There is no association between family and health Insurance purchase Initiation

H02: Family has a role in evaluation of alternatives

H12: Family does not have a role in evaluation of alternatives

H03: An association exists between HI purchase and the final decision made by the Family


Methodologies:

The following methodologies were adopted for this study:

Type and Design of the Study:

This study is exploratory in nature and attempt was taken to explore the roles

adopted by various members of the family.

Sample Criteria:

The scope of this research encompassed the family’s decision-making process

while buying health insurance in India. The sampling technique used was

convenient sampling. Due to scarcity of resources equal representation in each

8

of the resources category could not be reached. A total of 80 samples were

collected for this study.

Sample Selection:

The sample is restricted to Indian families residing in metros and Tier-II cities.

Data Collection:

Data were collected from both primary and secondary sources. The secondary

source includes internet, brochures, pamphlets, published and unpublished

reports etc, where as the primary sources include, interactions, structured and

unstructured interviews, administration of questionnaire, directive brain

storming etc.

Analysis:

The data analysis has been done using frequency and Chi square tests to find

out the implications as set in the objectives.

Questionnaire description

The interviewees to whom the questionnaire was administered were assured of

anonymity. The survey was conducted online with the help of googledocs. The

questionnaire was mostly of close ended type except for one question which

required short open ended answers. The questionnaire for this study is shown

in Annexure 1.

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Result Analysis and Discussion

The Authors consolidated the information received through both primary and secondary

research material and the following analysis was done.

The demographic analysis showed that out of the 80 respondents, 18 belonged to the age

group of 26-30 and 15 belonged to the age group of 31-35. This constituted 42% of the

respondents. The age group 26-30 and 31-35 seems to be more sensitive towards purchasing

Health Insurance. If we go by theory, the first stage is primarily the bachelor and new married

stage without children. Out of the 18 respondents belonging to the age group of 26-30, 9 are

single and 9 are married with no children. It is interesting to note that all the people belonging

to these two groups already have a Health Insurance, barring 9. The gender distribution is as

follows. 13 of the respondents are women and 67 are men. Out of the 3 female respondents, 4

are single (either divorced /widow or spinster).

Age

Frequency Percent Valid Percent Cumulative Percent

Valid 18-25 9 11.2 11.2 11.2

26-30 18 22.5 22.5 33.8

31-35 15 18.8 18.8 52.5

36-40 12 15.0 15.0 67.5

41-50 12 15.0 15.0 82.5

51-60 8 10.0 10.0 92.5

>60 6 7.5 7.5 100.0

Total 80 100.0 100.0

Gender


Valid male 67 83.8 83.8 83.8

2 13 16.2 16.2 100.0

Total 80 100.0 100.0

Marital Status


10

Age


Valid 18-25 9 11.2 11.2 11.2

26-30 18 22.5 22.5 33.8

31-35 15 18.8 18.8 52.5

36-40 12 15.0 15.0 67.5

41-50 12 15.0 15.0 82.5

51-60 8 10.0 10.0 92.5

>60 6 7.5 7.5 100.0

Valid married 51 63.8 63.8 63.8

single 29 36.2 36.2 100.0

Total 80 100.0 100.0

Table 1-Demography

72% of the respondents said they have Health Insurance.

HaveHI

Frequency Percent Valid Percent

Cumulative

Percent

Valid yes 58 72.5 72.5 72.5

no 22 27.5 27.5 100.0

Total 80 100.0 100.0

Table 2- Percentage of respondents having Health Insurance

Stages of HI Decision making

The following set of analysis took care of the first objective ie to understand the

family’s decision making process. As per the literature on Consumer Behavior and

Decision making, it is seen that decision making has 5 stages-initiations being the first

stage. The following frequency analysis table gives a snapshot of the initiative stage

of decision making.

11

Initiative


Valid you 55 68.8 70.5 70.5

spouse 7 8.8 9.0 79.5

Parents 7 8.8 9.0 88.5

Children 9 11.2 11.5 100.0

Total 78 97.5 100.0

Missing System 2 2.5

Total 80 100.0

Table 3- Initiative for HI purchase

In 69% of the cases, the respondent himself took the initiative to purchase HI. Spouse

influence was only 9%. Out of these 55 respondents who are the initiators themselves, 8 are

female. Out of the 47 male respondents who themselves took the initiative to buy HI, 32 were

married. And even after that the spouse initiative is on a lower side. Out of these 32 married

respondents, 11 of the respondents’ wives are working ladies. If we go buy the recent

research on spouse influence, it can be said that working wives’ influence in initializing a

buying decision is reducing.

In all the 7 cases, where the Parents played the initiator’s role, the respondent is single

barring one. So, it can be said that a small percentage of single bachelors are still not the

initiators as far as buying HI is concerned. 9 respondents said that their children took the

initiative. When we look at the demography of these 9 respondents, we find that all are in

between 50-60 barring 2. Hence, it is evident that people beyond 50 and dependant on their

children are not the initiators.

Information search

12

InfoSearch


Valid You 55 68.8 72.4 72.4

Spouse 7 8.8 9.2 81.6

Parents 6 7.5 7.9 89.5

Children 8 10.0 10.5 100.0

Total 76 95.0 100.0


Total 80 100.0

Table 4- Information search for HI purchase

Information sourcing, an important stage in buying process, too shows a similar kind of

nature. Spouse influence is same as compared to Initiation.

Evaluation of alternatives

AlternativeEval


Valid Single 45 56.2 56.2 56.2

Joint 35 43.8 43.8 100.0

Total 80 100.0 100.0

Table 5- Evaluation of Alternatives for HI purchase

It is interesting to note that evaluation of alternatives is a joint effort in the family. This

shows that Indian families together evaluate the alternatives available to them as far as HI

family decision making process is concerned. Since HI is a financial product, the entire

family’s role becomes prominant.

Final decision

Finaldecesion


Valid You 47 58.8 58.8 62.7

Spouse 16 20.0 20.0 78.8

Parents 7 8.8 8.8 87.6

Children 10 12.4 12.4 100.00

13

Finaldecesion

Total 80 100 100

Table 6- Final Decisionmaker on HI purchase in the family

Here comes an interesting point to note. The married respondents depend on their spouses to

make the final decision.

Final buyer

Buyer


Valid You 55 68.8 72.4 72.4

Spouse 7 8.8 9.2 81.6

Parents 6 7.5 7.9 89.5

Children 8 10.0 10.5 100.0

Total 76 95.0 100.0


Total 80 100.0

Table 7- Final HI buyer in the family

The final purchaser in 69% of the cases is the respondent himself.

Source of Information

Friends and Peers 43 57%

Internet 40 53%

Company Website 34 45%

Company Representative 36 47%

Social Networking Websites 7 9%

Newspaper 4 5%

Business/News Channel review 6 8%

Other 0 0%

Table 8- Source of Information

Friends and peers seem to be the best source of information. It shows that Indian customers

still rely on traditional means of information seeking. However, Internet scores and company

representatives are the second options.

14

The second objective that the authors had in their mind was to find out the factors affecting

Health Insurance purchase decision

Premium 51 67%

Product Features 69 91%

Company Brand and Image 38 50%

Service 66 87%

Network Hospitals 33 43%

OPD benefits 16 21%

Tax benefits 9 12%

Capping & Loading 1 1%

Portability benefits 2 3%

Table 8: factors affecting Health Insurance purchase decision

If we look at the factors which are important for a customer before deciding on a HI

purchase, Product features are the most important factor, followed by service. The authors

would take up further research using Factor analysis to find out the most important factor

having the highest loading.

Factor influence behind Health Insurance purchase

A touching Advertisement 1 1%

A family member's death/disability/health problem 25 31%

A friend's or peer's death/disability/health problem 13 16%

Doctor's Recommendation 8 10%

Forceful selling by Sales person 1 1%

Friends'/Peers/Relatives Recommendation 13 16%

Other 19 24%

Table 9: Factor influence behind Health Insurance purchase

It is interesting to note that the factor that influenced them to buy a Health Insurance product

is some mishap in their family. It could be death, disability or health problem. Another factor

is mishap in their friends’ or peers’ family. Thus it is evident that HI is felt to be important

only after there is some sort of mishappenings faced or seen by the respondents. It shows that

people are still reactive and not proactive as far as buying HI is concerned. However, further

15

research can help us to conclude which factor has the highest loading in terms of affecting the

purchase initiation.

Hypothesis Testing

The authors have come up with three hypotheses, the first one being

H01: There is an association between family and health Insurance purchase Initiation

The alternative Hypothesis is:

H11: There is no association between family and health Insurance purchase Initiation

The null Hypothesis was tested using Chi Square with 95% confidence level and the result

showed that the significance was 0.022 (P<0.05), thus rejecting null hypothesis. Hence we

can accept the alternate hypothesis and say that there is no significant association between HI

purchase and the initiation by the family.

Case Processing Summary

Cases

Valid Missing Total

N Percent N Percent N Percent

Initiative * HaveHI 78 97.5% 2 2.5% 80 100.0%

Chi-Square Tests

Value df

Asymp. Sig. (2-

sided)

Pearson Chi-Square 9.659a 3 .022

Likelihood Ratio 13.915 3 .003

Linear-by-Linear Association 8.864 1 .003

N of Valid Cases 78

a. 3 cells (37.5%) have expected count less than 5. The minimum

expected count is 1.97.

16

Initiative * HaveHI Crosstabulation

HaveHI

Totalyes no

Initiative you Count 34 21 55

Expected Count 39.5 15.5 55.0

spouse Count 6 1 7


Parents Count 7 0 7


Children Count 9 0 9


Total Count 56 22 78


Table 10: Chi Square Test Summary for Association between Initiation and HI Purchase

The second Hypothesis was

H02: Family has a role in evaluation of alternatives

The Alternative Hypothesis was

H12: Family does not have a role in evaluation of alternatives

Through this hypothesis the authors wanted to test whether Evaluation of alternatives is a

joint decision or not. The resultant Chi Square summary shows that there is high significant

association between alternative evaluation and HI purchase. P value = 0.231(P>0.05). Hence

Null Hypothesis accepted.


Cases

Valid Missing Total


AlternativeEval * HaveHI 80 100.0% 0 .0% 80 100.0%

17

AlternativeEval * HaveHI Crosstabulation

HaveHI

Totalyes no

AlternativeEval Single Count 35 10 45


Joint Count 23 12 35




Chi-Square Tests

Value df

Asymp. Sig. (2-

sided)

Exact Sig. (2-

sided)

Exact Sig. (1-

sided)


Continuity Correctionb.896 1 .344


Fisher's Exact Test .313 .172


N of Valid Casesb80

a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 9.63.

b. Computed only for a 2x2 table

Table 11: Chi Square Test Summary for Association between family role and evaluation of alternatives

The third Hypothesis that was tested was



The authors used Chi Square test to find the association. The result showed a significant

association between Final decision and HI purchase. P value = 0.251(P>0.05), thus accepting

the Null Hypothesis.

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Cases

Valid Missing Total


Finaldecesion * HaveHI 75 93.8% 5 6.2% 80 100.0%

Finaldecesion * HaveHI Crosstabulation

HaveHI

Totalyes no

Finaldecesion You Count 32 15 47


Spouse Count 6 5 11


Parents Count 6 1 7


Children Count 9 1 10




Chi-Square Tests

Value df

Asymp. Sig. (2-

sided)




N of Valid Cases 75

a. 4 cells (50.0%) have expected count less than 5. The minimum

expected count is 2.05.

Table 12: Chi Square Test Summary for Association between Final decision and HI Purchase

19

One of the important objectives that the authors had in this paper was to come up with a

framework for purchasing Health Insurance. Following Figure shows the Framework for

Health Insurance Buying pattern.

20

Figure 1. Framework on Health Insurance Buying Pattern

Post purchase Evaluation After Claim

Need to purchase Health Insurance

Information Search

Primary Sources- Relatives, Friends, PeersSecondary Sources- Internet, Company Website, IRDA, Insurance comparison portal

Identification/Evaluation of Alternatives

Premium, features, services

Purchase Decision Purchase

Product Influence

PremiumCashless FacilitiesCritical Illness BenefitAccidental ProtectionNo Claim BonusPre-existing DiseaseWaiting Period Clause No of diseases covered Portability

External InfluenceNegative word of mouth by friends/peers and relativesAttractive offer by the competitor

Financial Influence

Income

Service InfluenceNetwork HospitalsHassle-free ClaimAssistance by TPAProactiveness of

TPA/Co./Hospital

Rising Medical Expenses Change in Lifestyle Low healthcare expenses

(Public/Private)

Conclusion

This research was based on the widely accepted premise that it is the couple rather than

the individual that is the critical decision-making unit for many consumer purchase

decisions. The authors in this research tried to find out the decision making process of a

family while purchasing a financial product like Health Insurance.

It is concluded from the research that the need for purchasing HI came only after the family

faced some unforeseen events related to rising medical expenses which lead to economic and

emotional imbalance of the family. However, the need is further strengthened by initiation of

friends/peers and relatives and substantiated by websites and other secondary sources.

Health Insurance is the prerogative of the male earning member of the family. However,

wife’s role cannot be ignored as she contributes more during the evaluation of alternatives.

Even though Health Insurance buying initiation, information search and final decision is a

single activity, evaluation of alternatives is a joint activity wherein even the children and

elderly parents play some roles. Actual evaluation is done by the male earning member of the

family based on numerous criteria like premium, product feature and service.

Ultimately, a choice set is created which is again affected by situational factors like financial

influence (Family Income) and service influence (Network Hospitals, assistance by Third

Party Administrator, hassle-free claim, proactiveness of co, TPA, Hospitals).

Post purchase feedback of customers depends upon the services rendered by the HI

Company, TPA and the network hospital. Services include hassle-free claim settlement,

quality of treatment, individual attention given to the customer etc. This feedback is very

important from the perspective of the company because it would generate more referrals,

positive word of mouth and ultimately more business.

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Websites and URLs

http://surveysystem.com/sscalc.htm

http://www.president.kg/docs/const_2006rv/

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buying-decision-behavior.html

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