Framing and Willingness to Pay for a Local Health Department: Evidence from a COVID-19 Contingent Valuation Experiment

Abstract

Context: Local health departments provide essential public health services, yet many counties lack them, and those that exist struggle with ongoing funding needs. The COVID-19 pandemic politicized public health, raising questions about how political framing affects public willingness to pay for these services.

Methods: Participants in a contingent valuation experiment (N = 1,946) were recruited from Lancaster County in south-central Pennsylvania. They received information about local health department services and were randomized into conditions emphasizing either COVID-19 prevention or elevated blood lead level reduction–a less politically salient public health threat. Using interval regression, we estimate willingness to pay (WTP) for local health department services, identify its determinants, and examine treatment effects by party affiliation.

Findings: Mean annual WTP for local health department services was $138.22 (95% CI: $121.34, $139.73). Republicans showed a $165.60 lower WTP to pay than Democrats (p < 0.001). We observed no statistical differences within political affiliations to issue framing.

Conclusions: Partisan differences in support for local health departments persist, yet preferences remain stable across politicized frames. These findings suggest that polarization in public health attitudes reflects entrenched partisan identities more than frame-dependent views, underscoring the need for strategies that build durable cross-partisan trust and institutional legitimacy.