Public Opinion and Attributions for Health Care Costs
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Principal investigator:
Katherine McCabe
Rutgers University
Email: k.mccabe@rutgers.edu
Homepage:
http://www.katherinetmccabe.com/
Sample size: 2016
Field period: 01/22/2018-04/30/2018
Abstract
Many people in the United States face the burden of unexpected, costly medical expenses. According to a Kaiser Family Foundation poll in September 2015, 26% of U.S. adults report that they or someone in their household has had difficulty paying medical bills in the past 12 months. However, despite the prevalence of unexpected medical bills and the severity of their consequences, it remains unclear whether experiences with these health care costs influence public opinion on government actions that can shape these experiences. This study assesses how individuals attribute blame for these experiences and the extent to which individuals tend to connect their personal experience with unexpected medical bills to government. An experimental design varies the salience of different situations in which individuals might face unexpected medical bills and then examines how individuals attribute blame for and whom individuals contact about these experiences. Overall, blame for unexpected medical bills is relatively diffuse, with insurance companies and providers being most likely to receive blame, particularly in situations where their role is made relatively more salient. Providing respondents with a cue suggesting that the government has the potential to address health care costs did not significantly alter the effects for blame toward providers and insurance companies.
Hypotheses
How does variation in the salience of certain actors in contexts where people receive unexpected medical bills affect attributions of blame for these expenses? To what extent do individuals make the connection between their personal experience with unexpected medical bills and government?
Experimental Manipulations
Subjects are randomly assigned into one of five experimental conditions, delivered as different versions of a survey question.
Control condition: Individuals proceed directly to the outcome measures.
Insurance condition: individuals are prompted to read about a situation in which individuals might confront an unexpected health care cost when their insurance plan does not pay for medical treatment. Individuals are asked if they have had or heard about this experience.
Provider condition: individuals are prompted to read about a similar situation. The variation is that in this treatment the situation is one that emphasizes the role of the health care provider, instead of insurance. Individuals are asked if they have had or heard about this experience.
In the last two treatment conditions, a cue is added to provide a contextual link between one’s personal experience with unexpected health care costs and the government conversation on health care.
Insurance + Government Cue condition and Provider + Government Cue condition: individuals receive the following text prior to the prompt about unexpected health care costs: "Some people want Democrats and Republicans in government to address the costs of health care."
Outcomes
Attribution:
Suppose you received an unexpected medical bill, and the amount you had to pay out-of-pocket was expensive and difficult to pay in full. If you received this type of medical bill, who would deserve the blame for your experience?
Rank the following, where 1= deserves the most blame, 2= the second most blame, 3= the third most blame, 4= the fourth most blame, 5= the least blame. Response Options: Republicans in government, for failing to address rising health care costs.; Democrats in government, for failing to address rising health care costs.; A health care provider, for failing to be transparent about costs or provide affordable services.; A health insurance company, for failing to provide adequate coverage for medical care.; You, as the consumer, for failing to save enough money or purchase adequate health insurance.
Contact:
Suppose you received an unexpected medical bill, and the amount you had to pay out-of-pocket was expensive and difficult to pay in full. Which of the following people would you contact about the bill?
Rate each group of people on a scale from “Definitely would not contact” to “Definitely would contact.” Response Options: A congressman or senator's office; A government health or consumer protection agency; An insurance company; A health care provider (e.g., hospital, clinic); A lawyer; Your family; Your friends
Summary of Results
On average, individuals in the Provider and Insurance conditions ranked health care providers or insurance companies significantly higher in terms of blame, respectively, relative to the Control condition. In the Insurance and Provider conditions, Democrats and Republicans in government also received slightly less blame, but this is not significant. Providing a government cue in the Provider + Government Cue and Insurance + Government Cue conditions did not significantly alter the effects for blame toward providers and insurance companies relative to the Control condition. In these conditions, consumers received less blame. Thus, governmental cues may help move blame away from being perceived as a personal problem, but not necessarily shift blame away from private actors. Similar to the blame attribution results, respondents are significantly more likely to contact insurance companies and providers than they are to contact Congress or a government agency. This remains true even in conditions where a government cue is provided.