How Information and Identity Influence Attitudes and Attributions on Health Care

• In Event: Affordability of Healthcare: Perceptions and Policy Responses

Abstract

The substantial majority of the public in the United States views health care costs as a top priority for the president and Congress to address. Medical bills have caused many Americans to deplete their savings, take out loans, declare bankruptcy, and put off additional medical care (Kaiser Family Foundation 2016). However, there is less consensus on what the public wants government to do about these costs and for which costs the public believes government is ultimately responsible. Instead, partisanship and ideological orientations rule public opinion on most major health care issues.

In this study, I first conduct two surveys/survey experiments to understand the conditions under which the public—and partisans—are more likely to want government to intervene on behalf of patients. Using a conjoint experimental framework, I vary the amount and type of information present about medical bills a patient might experience. This includes the type of incident, the social identity of the patient—including race, gender, socioeconomic status, and age—whether the patient had insurance, and the nature and extent of the health care expenses. I also exogenously manipulate whether broader contextual information is present to link the patient’s experience to other experiences or discussions about health care policy.

For each type of medical bill, I ask respondents whether the patient should ultimately be responsible for paying the full cost of medical care, and if public policy should be passed to prevent the patient for incurring this type of medical cost. Furthermore, I probe whether the public is likely to hold elected officials accountable for any current lack of action in addressing rising health care costs.

In a final section, I use the results of the study to suggest how media coverage of health care costs might influence public opinion on health policy, building on Huff and Kertzer’s (2018) media content analysis research design. If media systematically focus on certain aspects of the patient or patient experience—but not others—I argue this can influence the public’s overall perceptions of the demand for public policy to address health care costs.

The results of the study point to the conditions under which information about actual health care experiences overcome partisan and ideological biases in attitudes on certain aspects of health policy. However, the findings also point to other biases—such as race- and class-based—perceptions that may make it more difficult to gain public consensus even on more narrow features of the health care system.

Author

• Katherine McCabe, Rutgers University