1. Examining psychological variables that predict attitudes and behavioral intentions regarding the Affordable Care Act
Ashley Ritter, Kristina Lamb, Jordan Baxter, Emily Cline, and Len Lecci
University of North Carolina Wilmington, Psychology Department
ABSTRACT
METHOD
RESULTS
DISCUSSION
In a national sample of 480 it was shown that priming cancer threat predicted cancer concern. Priming the cost of treating cancer predicted willingness to pay for health insurance. Health locus of control and neuroticism predicted health concern. Health anxiety predicted concern and willingness to pay.
Participants
480 participants, 56.9% female
Aged 18 to 64 (M = 34.79, SD = 11.49)
73% White, 11% Hispanic, 9% Black
Sample was educated (12% High School or GED, 30% Some College, 37% B.A.)
40% Democrat, 19% Republican, 4% Libertarian, 1% Green Party, 32% Independent, 4% Unaffiliated
73% had insurance, 27% uninsured
Materials and Procedure
Anonymous online survey, approximately 10 minutes in length, for $0.20 reward.
Screened out participants < 18 or > 64 years, who have/had cancer, and those on Medicaid.
Randomly assigned to a high or no threat condition, and a high or no cost condition.
Threat condition: Primed with facts regarding the incidence of cancer-related deaths.
Cost Condition: Primed with facts regarding the cost of treating cancer.
Questionnaire split into four sections: demographic questions, personality measures, manipulation, and questions of interest
Personality measures included the Whiteley Index, Multidimensional Health Locus of Control, and Big Five Index-10
Variable Coding
In all analyses, conservatism was a covariate.
Democrats and Green Party were considered liberal (-1), Independents and unaffiliated neutral (0), and Republicans and Libertarians conservative (1)
The cost manipulation significantly predicted how much individuals were willing to pay monthly for health insurance, F(1,479) = 3.04, p = .04, such that those participants primed by the cost of treating cancer were willing to pay more per month (M = , SE = 7.36) than those that were not primed (M = , SE = 7.55)
Figure 1
Figure 2
Outcomes
Figure 1 displays the two-way interaction between perceived susceptibility and chance control, such that when chance control is low, participants displayed more concern for cancer when primed with perceived susceptibility.
Figure 2 displays the three-way interaction between perceived susceptibility, cost manipulation, and internal control. For those primed with perceived susceptibility (top panel), concern for cancer was higher for those with low internal control only when cost was primed. When there was no susceptibility prime (bottom panel), concern for cancer was higher for those with low internal control but only when cost was not primed.
Manipulation Design
Despite the manipulation containing only a few facts to prime a reaction, the outcome was both specific and domain- consistent
The manipulation check allowed us to remove a subset (15%) of the sample who claimed not to believe the factual statements. The effects for perceived susceptibility and cost were absent in that group. Interestingly, these individuals considered the cost of health insurance as less important when primed for the cost of treating cancer.
Implications
The ACA is still a partisan topic, and topics relating to it (such as health care reform) are viewed in the same political lens. Neither are predicted by psychological variables in this study; conservatism had the highest effect sizes for related questions. In fact, priming a certain group (those who do not believe the manipulation) produced an unwanted effect.
This study suggests that it is possible to prime people with simple statements about the cost of treating illnesses, and this can impact willingness to pay for health insurance. Other studies have likewise suggested that simple, brief statements can impact outcomes (Lecci & Cohen, 2007).
Consistent with the literature on HBM, health threat primes do not influence willingness to pay. Our study suggests that preventative health campaigns should focus less on activating illness threat and more on educating individuals about the cost of treatment.
BACKGROUND
Affordable Care Act (ACA)
Signed on March 23, 2010 by President Obama
Divisive split based on political party lines, with slightly fewer in favor overall
Health Belief Model (HBM)
Consists of four dimensions; two related to perceived threat (susceptibility/severity) and two related to perceived cost (benefits/barriers).
Internal stimulus (symptom), or an external stimulus (news story) may be required (Janz & Becker, 1984)
Meta-analysis showed that perceived susceptibility and perceived threat are the weakest predictors of behavior, while benefits and barriers are the strongest predictors (Carpenter, 2010)
Priming
Implicit (unconscious) memory effect where exposure to a stimulus influences later associations and behaviors (Bargh & Chartrand, 2000)
Previous research shows that it is possible to prime health-related information (Pavey & Sparks, 2012; Meerman, Brosschot, & Verkuil, 2013)
Hypotheses
Priming susceptibility will have weakest effects, while priming cost will have the strongest effects
Effects will be domain-consistent and specific
Effects will be mediated by individual personality differences, specifically for those while high health anxiety, high neuroticism, and low internal control