Is it unfair for the affluent to be able to purchase “better” healthcare? Existential standards and institutional norms in healthcare attitudes across 28 countries

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• dc.contributor.author Immergut, Ellen M.
• dc.contributor.author Schneider, Simone M.
• dc.date.accessioned 2023-05-17T06:00:16Z
• dc.date.available 2023-05-17T06:00:16Z
• dc.date.issued 2020
• dc.description.abstract Existing research has found that individuals often perceive healthcare inequalities as unfair; yet, there is high variation in unfairness perceptions between countries. This raises the question of whether the institutional context of the healthcare system is associated with what people perceive as unfair. Using data from the ISSP study and OECD health expenditure data from 2011/13, we explore whether individual attitudes about the unfairness of healthcare inequality – the ability to purchase “better” healthcare for the affluent – vary systematically with a country's institutional environment: namely, with the prevalence of cost barriers to healthcare access, and with the degree and type of public healthcare financing. Three general findings emerge from the analysis: (1) Higher cost barriers correlate with lower levels of perceived unfairness in healthcare inequality, suggesting those exposed to greater levels of inequality tend to be more accepting of inequality. This finding is consistent with empirical justice theory and the expected relevance of an ‘existential’ standard of justice, stemming from individuals' proclivities to accept the status quo as just. (2) Further, greater public financing of healthcare correlates with higher perceived unfairness. Drawing on neo-institutionalist theory, this may suggest that greater public financing enshrines access to healthcare as a universal right, and hence provides an ideational framing that delegitimizes unequal opportunities for purchasing better healthcare. (3) Further, higher unfairness perceptions of lower income and educational groups are more strongly associated with greater public financing than those of their respective comparison groups. This may indicate that the normative right to healthcare is of particular importance to the disadvantaged, which could potentially explain the political quiescence on healthcare of lower income and educated persons in societies that lack universal health systems. In sum, this study contributes to the larger debate on the interrelatedness of healthcare institutions and public opinion, and specifically on perceptions of unfairness.
• dc.description.sponsorship This research is part of the NORFACE Welfare State Futures funded research project ‘The Paradox of Health State Futures’ (HEALTHDOX) (File Number 462-14-070, with EC ERA-Net Plus funding, grant agreement number 618106).
• dc.format.mimetype application/pdf
• dc.identifier.citation Immergut EM, Schneider SM. Is it unfair for the affluent to be able to purchase “better” healthcare? Existential standards and institutional norms in healthcare attitudes across 28 countries. Soc Sci Med. 2020;267:113146. DOI: 10.1016/j.socscimed.2020.113146
• dc.identifier.doi http://dx.doi.org/10.1016/j.socscimed.2020.113146
• dc.identifier.issn 0277-9536
• dc.identifier.uri http://hdl.handle.net/10230/56860
• dc.language.iso eng
• dc.publisher Elsevier
• dc.relation.ispartof Social Science & Medicine. 2020;267:113146.
• dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/618106
• dc.rights © 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
• dc.subject.keyword Healthcare inequality
• dc.subject.keyword Neo-institutionalist theory
• dc.subject.keyword Health expenditure
• dc.subject.keyword Fairness
• dc.subject.keyword Public opinion
• dc.title Is it unfair for the affluent to be able to purchase “better” healthcare? Existential standards and institutional norms in healthcare attitudes across 28 countries
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion