The first-to-test bias: Impact of testing order on assigning responsibility for contagion.

When a contagious disease spreads, people wonder about who to blame for transmission. Herein, we document a novel bias, the "First-To-Test" bias, that emerges when individuals assign responsibility for contagion within a dyad. People tend to believe that the member of the dyad who tested positive first is more likely to have given the disease to the other member, even when all other relevant factors are held constant. That is, while using testing order as a basis for assigning responsibility for a dyad's contraction of a contagious disease may be rational in cases where all other relevant factors are not held constant, we show that individuals are more likely to allocate responsibility to whoever tested positive first even when these relevant factors are held constant. This overgeneralization bias emerges regardless of whether the evaluator is an outside observer or the member of the dyad who tested positive first. While we explore this bias with COVID-19 and strep throat, it has implications for other contagious diseases such as sexually transmitted infections (STIs) and illnesses often spread among school children (e.g., influenza, whooping cough). We conclude by discussing its implications for patients and organizations.

Untangling the roots of the West Virginia opioid crisis: relationships in adolescent pregnancy, drug misuse, and future outcomes.

Context: West Virginia (WV) is afflicted by high rates of teenage pregnancy and births, opioid usage during pregnancy, and Neonatal Abstinence Syndrome births. Current efforts are ineffective at reducing teenage pregnancy and opioid misuse. While pregnancy and opioid usage may appear to be separate issues, a number of associations suggest adolescent pregnancy, opioid use, and other health-related outcomes are part of a cluster of negative health conditions that should be addressed holistically. Objective: To determine whether there is an association between teenage pregnancy and negative health outcomes, including opioid misuse, among WV adolescent girls. Methods: This study was conducted from July 2018 to March 2019. We obtained the most recently-available aggregate data at the county level for each of the 55 WV counties from the WV Department of Health and Human Resources (WVDHHR) on July 30, 2018, and we analyzed it during the fall of 2018. Raw data regarding pregnancy-related outcomes included WV girls between the ages of 15 and 19, was acquired between 2014 and 2017 by county, and was provided by the WVDHHR as a mean taken across all four years. Raw data regarding opioid misuse outcomes and heart-health variables included WV girls and women of all ages, was collected between 2014 and 2017 by county, and was provided by the WVDHHR as a mean taken across all four years, unless stated otherwise. Pearson correlation analysis was utilized to examine the associations between the teenage pregnancy and birth rates, opioid misuse, pregnancy, and heart-health-related statistics, as well as environmental variables. Results: Teenage pregnancy and birth rates were positively associated with fetal death rates (r=0.308, p<0.05 and r=0.261, p<0.10, respectively). The rate of fetal death among mothers aged 15-19 years was higher in counties with higher teenage pregnancy and birth rates. As the pregnancy and birth rates increased, the rate of abortion increased even more (r=0.434 and r=0.304 respectively, both p<0.05). Teenage pregnancy and birth rates were associated with opioid overdose death rates for all WV girls and women (Pearson correlations, r=0.444 and 0.418 respectively, both p<0.01). WV counties with higher pregnancy and birth rates among girls aged 15-19 years had a greater proportion of women dying from opioid overdose. Teenage pregnancy and birth rates were both positively correlated with obesity, physical inactivity, high cholesterol, and high blood pressure (all r>0.39, all p<0.05). Neither the high-school dropout rate nor the number of WVDHHR listed clinics were associated with teenage pregnancy or birth rates (p>0.10). Conclusion: Reduction of unintended teenage pregnancy may be viewed as a nontraditional, holistic, method of ameliorating the opioid misuse crisis in the state of WV. This recommendation should be part of a multi-pronged approach to mitigating the opioid epidemic in WV and all of Appalachia.

Strategies for policy evaluation of health insurance marketplaces.

Millions of Americans have access to health insurance through new health insurance marketplaces. To serve the uninsured and underinsured populations, it is vital that key stakeholders put into place robust policy evaluation processes to capture data and provide timely feedback regarding exchange functions. This article lays a foundation for policy evaluation that includes health outcomes, economic outcomes, and consumer processes and perceptions. The evaluation methods outlined are easily adaptable to state, federal, and partnership marketplaces. The article provides a road map for insurance marketplace evaluation at any level and encourages a consistent approach that allows comparison across various marketplaces.

Awareness and Interest in the West Virginia Health Insurance Marketplace.

The objective of this study is to examine the level of awareness of and interest in the Health Insurance Marketplace in West Virginia. Primary survey data were collected in July/August 2013 from a stratified sampling of West Virginians. A mailed survey was completed by respondents in a cross-sectional study. Key variables included general awareness of the Health Insurance Marketplace and the availability of subsidies, the individual mandate, interest in using the Marketplace, and perceptions of respondents' ability to qualify for financial assistance. A total of 6000 surveys were mailed containing a 9-page questionnaire; 1198 completed surveys were returned. Two months prior to launch, awareness of the Health Insurance Marketplace was low in West Virginia, yet interest in the Marketplace was higher among those most likely to benefit--the uninsured and residents likely to qualify for financial subsidies. West Virginians reported being familiar with the individual mandate. Efforts should be increased among government and nongovernment organizations at the federal, state, and local levels to heighten awareness of the Health Insurance Marketplace in West Virginia and, particularly, the availability of subsidies. Many, once made aware, expressed interest in learning more.

Opting to opt-in: policy choice, program expectations and results in West Virginia's Medicaid reform initiative.

Following the passage of the Federal Deficit Reduction Act in 2005, a few states, including West Virginia, redesigned their Medicaid programs to emphasize personal responsibility and consumer-driven health decisions. The West Virginia program was implemented in 2006 and was subsequently abandoned in 2010 due to changes in Federal laws and continuing criticism by advocacy groups whose expectations for enrollment in a wellness-based plan were not met. Using the results of a survey of the West Virginia members, the authors explore the public policy and implementation factors of this program. We argue that initial policy design relied on existing implementation mechanisms, while it needed specific tactics to address the novelty of the choice members were facing. With the passage of the Patient Protection and Affordable Care Act, the West Virginia results provide valuable insights for future health reform policy implementation, especially as they relate to consumer-directed health decision-making and the role of intermediaries who can play a role in assisting consumers in their choices.

Health care reform through the eyes of patients: a qualitative look at Medicaid redesign.

This research examines consumer choice in Medicaid insurance plans. As part of the 2005 Federal Deficit Reduction Act, a number of states have implemented new Medicaid programs targeted to a subset of the Medicaid population. These programs offer consumers a choice of plans and this research examines consumer choice in one state's program. As part of a broader survey, participants were given the opportunity to explain, in their own words, why they selected their plan. We systematically interpret this qualitative data and then develop a series of propositions relating to Medicaid health care plan choice and marketing/public policy issues surrounding this choice.

Choice in public health insurance: evidence from West Virginia medicaid redesign.

This paper examines the factors that affect plan choice in a public health insurance program. West Virginia recently redesigned its state Medicaid program, offering members a choice between two plans--a basic plan and an enhanced plan. The latter plan includes more benefits, but requires additional agreements intended to lead patients to adopt healthier lifestyles. We use administrative claims records and survey data to examine plan choice. Our results yield convincing evidence that members with higher health care utilization patterns are more likely to enroll in the enhanced plan, but other factors such as education are also important.