Whose Health Deserves Investment? A Crowdfunding Conjoint Experiment

• In Event: Who Uses Public Health Resources and Who is Seen as Deserving of Doing So

Abstract

How do Americans assess whose health deserves investment? Previous studies suggest several criteria that shape assessments of deservingness, yet differ on which criteria dominate. Therefore, in a two-wave, nationally representative survey of nearly 3,000 Americans, we employ a novel conjoint experiment to test multiple hypotheses simultaneously and identify which considerations are decisive. The prevalent practice of crowdfunding for medical expenses provides a realistic context for the experiment, in which respondents consider two patient profiles with randomly assigned attributes and choose who should receive a donation. We simultaneously test a variant in which respondents decide who should receive generic government funding.

We know that Republicans and Democrats differ sharply on who should pay for healthcare, whether individuals, charitable organizations, or the government. In the experiment, however, Republican and Democratic respondents express largely similar views on whose health deserves investment. These similarities persist if they are allocating crowdfunding or government funding. Regardless of respondents’ partisanship, hypothetical patients with greater need (in the form of lower income and more dependents) were favored for investment. Patients with greater perceived control over their health condition, such as a former smoker who contracted lung cancer, were less favored.

On one dimension, however, Republicans’ and Democrats’ deservingness assessments differ decisively. Democrats, including white Democrats, viewed patients of color (Black, Hispanic, and Asian) as more deserving of investment. For Republicans, the hypothetical patients’ race/ethnicity did not affect investment decisions. The experiment’s October 2020 timing -- in the aftermath of mass protests against systemic racism, and in the lead-up to a racially polarized presidential election -- may influence these results, which bear investigation in future work.

Our findings validate hypotheses we developed in initial qualitative interviews with 170 health stakeholders in Greater Cleveland, Ohio, which suggest that despite partisan polarization on healthcare policy, Americans share similar underlying values on health deservingness that could be used productively in health policy messaging.

Authors

• Abigail Fisher Williamson, Trinity College

• Kristin Kay Lunz Trujillo, Harvard University

• Sarah S. Willen, University of Connecticut

• Colleen C. Walsh, Cleveland State University