Who Deserves Health Care?

The Effects of Causal Attributions and Group Cues on Public Attitudes about Responsibility for Health Care Costs

Individual judgments about causes of illness inform attitudes toward public policy and are largely based on personal beliefs, and stereotypes about race and class.

These researchers sought to determine how social group membership cues (race, class, gender) interact with likely causes of illness (behavioral, biological or systemic health care factors), and affect public attitudes toward providing social assistance for health care costs. They also assessed whether beliefs about causes of group differences in life expectancy (low-income African Americans live five years less than Whites) are related to preferences about government financing of health care.

Researchers created vignettes describing hypothetical health scenarios and gave respondents varying cues about the individual—Black, White, uninsured, working class, middle class, smoker, family history of heart disease, diabetes runs in the family, overweight, unhealthy eater—to determine how much they blame the individual for their illness and who should pay for the costs of medical care.

Respondents were more likely to blame individuals and less likely to believe society should pay their medical bills when their illness was linked to behavioral choices. Those who saw health inequities as resulting from behavior, rather than societal forces, were less likely to support a government role in providing health insurance.