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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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  • Immergut, Ellen M.
  • Schneider, Simone M.

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.

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  • Immergut, Ellen M. & Schneider, Simone M., 2020. "Is it unfair for the affluent to be able to purchase “better” healthcare? Existential standards and institutional norms in healthcare attitudes across 28 countries," Social Science & Medicine, Elsevier, vol. 267(C).
    • Handle: RePEc:eee:socmed:v:267:y:2020:i:c:s0277953620303658
    DOI: 10.1016/j.socscimed.2020.113146
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    References listed on IDEAS

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    1. Konow, James, 2001. "Fair and square: the four sides of distributive justice," Journal of Economic Behavior & Organization, Elsevier, vol. 46(2), pages 137-164, October.
    2. Gkiouleka, Anna & Huijts, Tim & Beckfield, Jason & Bambra, Clare, 2018. "Understanding the micro and macro politics of health: Inequalities, intersectionality & institutions - A research agenda," Social Science & Medicine, Elsevier, vol. 200(C), pages 92-98.
    3. Marmor, Theodore & Wendt, Claus, 2012. "Conceptual frameworks for comparing healthcare politics and policy," Health Policy, Elsevier, vol. 107(1), pages 11-20.
    4. Ellen M. Immergut, 1998. "The Theoretical Core of the New Institutionalism," Politics & Society, , vol. 26(1), pages 5-34, March.
    5. Hacker, Jacob S., 2004. "Review Article: Dismantling the Health Care State? Political Institutions, Public Policies and the Comparative Politics of Health Reform," British Journal of Political Science, Cambridge University Press, vol. 34(4), pages 693-724, October.
    6. Olafsdottir, Sigrun & Bakhtiari, Elyas & Barman, Emily, 2014. "Public or private? The role of the state and civil society in health and health inequalities across nations," Social Science & Medicine, Elsevier, vol. 123(C), pages 174-181.
    7. 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.
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    1. Aaltonen, Katri & Vaalavuo, Maria, 2024. "Financial burden of medicines in five Northern European countries: A decommodification perspective," Social Science & Medicine, Elsevier, vol. 347(C).

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