An East–West Comparison of Healthcare Evaluations in Europe: Do Institutions Matter?

by Tamara Popic and Simone M. Schneider (HEALTHDOX)

Existing research on differences in welfare attitudes in Eastern compared to Western Europe often explains these differences in terms of legacies – past institutions and socialization processes under the communist regime. Using data from the fourth round of the European Social Survey and applying multilevel and multilevel mediation analysis, we explore differences in evaluations of healthcare systems across the two regions. Our results support the institutional explanation, and point out that East–West differences in health evaluations are explained by differences in the current institutional design of healthcare systems in the two regions. We find that the lower evaluations of the healthcare system in the East are explained by institutional characteristics of the healthcare system, that is, lower financial resources, higher out-of-pocket payments, and lower supply of primary healthcare services in Eastern compared to Western European countries.

Our findings confirm prior research on institutional effects on attitudes, but also stress that not all aspects of the institutional set-up are equally relevant for citizen’s evaluations. Policies that determine the financial aspects of healthcare provision – the amount of resources invested in healthcare, the priority government assigns to the health sector and the way it manages the public–private mix – as well as the supply of healthcare personnel in primary care are more important for citizens’ evaluations, than policies that regulate access to care. Our results hence suggest that policymakers should be more careful when introducing policies that change the public–private mix, for example, by cutting public healthcare spending or introducing user fees for medical services, as these policies could backfire, worsening the perception of the healthcare system as a whole. Similarly, as evaluations improve with a higher number of GPs in the system, emphasis on primary care could improve the healthcare system’s reputation in the eyes of the public.

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