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Self-benefits, fiscal risk, and political support for the public healthcare system

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  • Kishishita, Daiki
  • Matsumoto, Tomoko

Abstract

The rapid aging of the population has become increasingly challenging for public healthcare systems. To ensure sustainability, governments must persuade their citizens to accept a larger burden, which is a difficult task. This study explored whether informing individuals of self-benefits from the healthcare system could be a solution. We first constructed a two-period overlapping generations model and hypothesized that doing so could facilitate political support for larger healthcare insurance contributions; however, this effect is reduced when people are concerned about fiscal sustainability due to a declining fertility rate. To test these hypotheses, we conducted an online survey experiment in Japan, in which the treatment group was informed of the benefits from the public healthcare system. We found that the treatment had no effect on average but augmented support for a larger burden among respondents who were unaware of fiscal unsustainability. Furthermore, this positive effect on optimistic respondents reduced once they were informed of the fiscal risks. Moreover, we analyzed the heterogeneity of the treatment effects depending on time and risk preferences.

Suggested Citation

  • Kishishita, Daiki & Matsumoto, Tomoko, 2024. "Self-benefits, fiscal risk, and political support for the public healthcare system," European Journal of Political Economy, Elsevier, vol. 85(C).
    • Handle: RePEc:eee:poleco:v:85:y:2024:i:c:s0176268024000995
    DOI: 10.1016/j.ejpoleco.2024.102597
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    1. Jacob, Johanna & Lundin, Douglas, 2005. "A median voter model of health insurance with ex post moral hazard," Journal of Health Economics, Elsevier, vol. 24(2), pages 407-426, March.
    2. Thomas Dohmen & Armin Falk & David Huffman & Uwe Sunde & Jürgen Schupp & Gert G. Wagner, 2011. "Individual Risk Attitudes: Measurement, Determinants, And Behavioral Consequences," Journal of the European Economic Association, European Economic Association, vol. 9(3), pages 522-550, June.
    3. Rehm, Philipp & Hacker, Jacob S. & Schlesinger, Mark, 2012. "Insecure Alliances: Risk, Inequality, and Support for the Welfare State," American Political Science Review, Cambridge University Press, vol. 106(2), pages 386-406, May.
    4. Kishishita, Daiki & Yamagishi, Atsushi & Matsumoto, Tomoko, 2023. "Overconfidence, income-ability gap, and preferences for income equality," European Journal of Political Economy, Elsevier, vol. 77(C).
    5. Minchung Hsu & Tomoaki Yamada, 2019. "Population Aging, Health Care, and Fiscal Policy Reform: The Challenges for Japan," Scandinavian Journal of Economics, Wiley Blackwell, vol. 121(2), pages 547-577, April.
    6. Ilyana Kuziemko & Michael I. Norton & Emmanuel Saez & Stefanie Stantcheva, 2015. "How Elastic Are Preferences for Redistribution? Evidence from Randomized Survey Experiments," American Economic Review, American Economic Association, vol. 105(4), pages 1478-1508, April.
    7. Jeske, Karsten & Kitao, Sagiri, 2009. "U.S. tax policy and health insurance demand: Can a regressive policy improve welfare?," Journal of Monetary Economics, Elsevier, vol. 56(2), pages 210-221, March.
    8. Alberto Alesina & Stefanie Stantcheva & Edoardo Teso, 2018. "Intergenerational Mobility and Preferences for Redistribution," American Economic Review, American Economic Association, vol. 108(2), pages 521-554, February.
    9. Kristoffer B Hvidberg & Claus T Kreiner & Stefanie Stantcheva, 2023. "Social Positions and Fairness Views on Inequality," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 90(6), pages 3083-3118.
    10. Diva Dhar & Tarun Jain & Seema Jayachandran, 2022. "Reshaping Adolescents' Gender Attitudes: Evidence from a School-Based Experiment in India," American Economic Review, American Economic Association, vol. 112(3), pages 899-927, March.
    11. Tito Boeri & Guido Tabellini, 2012. "Does information increase political support for pension reform?," Public Choice, Springer, vol. 150(1), pages 327-362, January.
    12. Stefanie Stantcheva, 2021. "Understanding Tax Policy: How do People Reason?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(4), pages 2309-2369.
    13. Gärtner, Manja & Mollerstrom, Johanna & Seim, David, 2017. "Individual risk preferences and the demand for redistribution," Journal of Public Economics, Elsevier, vol. 153(C), pages 49-55.
    14. Cruces, Guillermo & Perez-Truglia, Ricardo & Tetaz, Martin, 2013. "Biased perceptions of income distribution and preferences for redistribution: Evidence from a survey experiment," Journal of Public Economics, Elsevier, vol. 98(C), pages 100-112.
    15. Haizhen Mou, 2012. "The political economy of public health expenditure and wait times in a public‐private mixed health care system," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 45(4), pages 1640-1666, November.
    16. Armin Falk & Anke Becker & Thomas Dohmen & Benjamin Enke & David B. Huffman & Uwe Sunde, 2017. "Global Evidence on Economic Preferences," NBER Working Papers 23943, National Bureau of Economic Research, Inc.
    17. Haizhen Mou, 2012. "The political economy of public health expenditure and wait times in a public-private mixed health care system," Canadian Journal of Economics, Canadian Economics Association, vol. 45(4), pages 1640-1666, November.
    18. Armin Falk & Anke Becker & Thomas Dohmen & Benjamin Enke & David Huffman & Uwe Sunde, 2018. "Global Evidence on Economic Preferences," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 133(4), pages 1645-1692.
    19. Meltzer, Allan H & Richard, Scott F, 1981. "A Rational Theory of the Size of Government," Journal of Political Economy, University of Chicago Press, vol. 89(5), pages 914-927, October.
    20. Hsu, Minchung & Lee, Junsang, 2013. "The Provision Of Public Universal Health Insurance: Impacts On Private Insurance, Asset Holdings, And Welfare," Macroeconomic Dynamics, Cambridge University Press, vol. 17(6), pages 1252-1280, September.
    21. Bethencourt, Carlos & Galasso, Vincenzo, 2008. "Political complements in the welfare state: Health care and social security," Journal of Public Economics, Elsevier, vol. 92(3-4), pages 609-632, April.
    22. Rossignol, Stéphane, 2008. "Politics of social health insurance," European Journal of Political Economy, Elsevier, vol. 24(2), pages 387-401, June.
    23. Jacobs, Alan M. & Matthews, J. Scott, 2012. "Why Do Citizens Discount the Future? Public Opinion and the Timing of Policy Consequences," British Journal of Political Science, Cambridge University Press, vol. 42(4), pages 903-935, October.
    24. Campbell, Andrea Louise, 2002. "Self-Interest, Social Security, and the Distinctive Participation Patterns of Senior Citizens," American Political Science Review, Cambridge University Press, vol. 96(3), pages 565-574, September.
    25. Matias Giaccobasso & Brad C. Nathan & Ricardo Perez-Truglia & Alejandro Zentner, 2022. "Where Do My Tax Dollars Go? Tax Morale Effects of Perceived Government Spending," NBER Working Papers 29789, National Bureau of Economic Research, Inc.
    26. Carsten Jensen & Michael Bang Petersen, 2017. "The Deservingness Heuristic and the Politics of Health Care," American Journal of Political Science, John Wiley & Sons, vol. 61(1), pages 68-83, January.
    27. Galasso, Vincenzo & Profeta, Paola, 2007. "How does ageing affect the welfare state?," European Journal of Political Economy, Elsevier, vol. 23(2), pages 554-563, June.
    28. Christopher Hoy & Franziska Mager, 2021. "Why Are Relatively Poor People Not More Supportive of Redistribution? Evidence from a Randomized Survey Experiment across Ten Countries," American Economic Journal: Economic Policy, American Economic Association, vol. 13(4), pages 299-328, November.
    29. Papanicolas, Irene & Marino, Alberto & Lorenzoni, Luca & Jha, Ashish, 2020. "Comparison of health care spending by age in 8 high-income countries," LSE Research Online Documents on Economics 105109, London School of Economics and Political Science, LSE Library.
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    More about this item

    Keywords

    Healthcare system; Policy preference; Benefit; Fiscal unsustainability; Survey experiment;
    All these keywords.

    JEL classification:

    • D31 - Microeconomics - - Distribution - - - Personal Income and Wealth Distribution
    • H24 - Public Economics - - Taxation, Subsidies, and Revenue - - - Personal Income and Other Nonbusiness Taxes and Subsidies
    • H41 - Public Economics - - Publicly Provided Goods - - - Public Goods

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