IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v267y2020ics0277953620303658.html
   My bibliography  Save this article

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

Author

Listed:
  • 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.

Suggested Citation

  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953620303658
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2020.113146?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    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. Anonymous, 1948. "World Health Organization," International Organization, Cambridge University Press, vol. 2(2), pages 374-377, June.
    8. Anonymous, 1948. "World Health Organization," International Organization, Cambridge University Press, vol. 2(1), pages 138-140, February.
    9. 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.
    10. Anonymous, 1948. "World Health Organization," International Organization, Cambridge University Press, vol. 2(3), pages 540-542, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Odelia Koh & Jeannette Lee & Maudrene L S Tan & E-Shyong Tai & Ce Jin Foo & Kok Joon Chong & Su-Yen Goh & Yong Mong Bee & Julian Thumboo & Yin-Bun Cheung & Avjeet Singh & Hwee-Lin Wee, 2014. "Establishing the Thematic Framework for a Diabetes-Specific Health-Related Quality of Life Item Bank for Use in an English-Speaking Asian Population," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-12, December.
    2. Viola, Lora Anne, 2008. "WHO says competition is healthy: How civil society can change IGOs [Die WHO sagt: Wettbewerb ist gesund. Wie Zivilgesellschaft IGOs verändern kann]," Discussion Papers, Research Unit: Global Governance SP IV 2008-307, WZB Berlin Social Science Center.
    3. Letizia Appolloni & Alberto Giretti & Maria Vittoria Corazza & Daniela D’Alessandro, 2020. "Walkable Urban Environments: An Ergonomic Approach of Evaluation," Sustainability, MDPI, vol. 12(20), pages 1-31, October.
    4. João M. S. Carvalho & Célio A. A. Sousa, 2018. "Is Psychological Value a Missing Building Block in Societal Sustainability?," Sustainability, MDPI, vol. 10(12), pages 1-14, December.
    5. Völker, Sebastian & Kistemann, Thomas, 2013. "Reprint of: “I'm always entirely happy when I'm here!” Urban blue enhancing human health and well-being in Cologne and Düsseldorf, Germany," Social Science & Medicine, Elsevier, vol. 91(C), pages 141-152.
    6. Jozef Bavoľár & Oľga Orosová, 2015. "Decision-making styles and their associations with decision-making competencies and mental health," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 10(1), pages 115-122, January.
    7. Souad Smaili, 2018. "I Feel Myself in a Cage of Bird: Berber Female Students’ Self-Identification in the Algerian Society - A Phenomenological Study," European Journal of Social Sciences Articles, Revistia Research and Publishing, vol. 1, September.
    8. Amaresh Panda & Sanjay Mohapatra, 2021. "Online Healthcare Practices and Associated Stakeholders: Review of Literature for Future Research Agenda," Vikalpa: The Journal for Decision Makers, , vol. 46(2), pages 71-85, June.
    9. Tim Lomas & Kate Hefferon & Itai Ivtzan, 2015. "The LIFE Model: A Meta-Theoretical Conceptual Map for Applied Positive Psychology," Journal of Happiness Studies, Springer, vol. 16(5), pages 1347-1364, October.
    10. Jeanne Landgraf, 2001. "Measuring and monitoring quality of life in children and youth: A brief commentary," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 46(5), pages 281-282, September.
    11. Rock, Melanie J. & Degeling, Chris, 2015. "Public health ethics and more-than-human solidarity," Social Science & Medicine, Elsevier, vol. 129(C), pages 61-67.
    12. Çevik, Tuğçe, 2020. "Effects of Intimate Partner Violence on General Health Status," MPRA Paper 101346, University Library of Munich, Germany.
    13. Gulshan Kumar & Jagmohan Singh, 2020. "Health Infrastructure Disparities in Punjab: An Inter-district Analysis," Journal of Infrastructure Development, India Development Foundation, vol. 12(1), pages 25-38, June.
    14. repec:cup:judgdm:v:10:y:2015:i:1:p:115-122 is not listed on IDEAS
    15. Gibson, Barbara E. & Secker, Barbara & Rolfe, Debbie & Wagner, Frank & Parke, Bob & Mistry, Bhavnita, 2012. "Disability and dignity-enabling home environments," Social Science & Medicine, Elsevier, vol. 74(2), pages 211-219.
    16. Corey L. M. Keyes & Malik Muhammad Sohail & Nneka Jebose Molokwu & Heather Parnell & Cyrilla Amanya & Venkata Gopala Krishna Kaza & Yohannes Benyam Saddo & Vanroth Vann & Senti Tzudier & Rae Jean Proe, 2021. "How Would You Describe a Mentally Healthy Person? A Cross-Cultural Qualitative Study of Caregivers of Orphans and Separated Children," Journal of Happiness Studies, Springer, vol. 22(4), pages 1719-1743, April.
    17. Willard G. Manning, Jr. & Joseph P. Newhouse & John E. Ware, Jr., 1982. "The Status of Health in Demand Estimation; or, Beyond Excellent, Good, Fair, Poor," NBER Chapters, in: Economic Aspects of Health, pages 141-184, National Bureau of Economic Research, Inc.
    18. Bruns, Diedrich & Münderlein, Daniel, 2018. ""Paysage à votre santé". Gesundheitsfördernde Landschaften - Eine Betrachtung von Naturparken," Arbeitsberichte der ARL: Aufsätze, in: Weber, Florian & Weber, Friedericke & Jenal, Corinna (ed.), Wohin des Weges? Regionalentwicklung in Grossschutzgebieten, volume 21, pages 250-281, ARL – Akademie für Raumentwicklung in der Leibniz-Gemeinschaft.
    19. Stephen Birkett & David Rapport, 1998. "A framework for identifying and classifyingecosystem dysfunctions," Environment Systems and Decisions, Springer, vol. 18(1), pages 15-25, March.
    20. Stronach, Megan & Maxwell, Hazel & Pearce, Sonya, 2019. "Indigenous Australian women promoting health through sport," Sport Management Review, Elsevier, vol. 22(1), pages 5-20.
    21. Asfaw, Abay & Klasen, Stephan & Lamanna, Francesca, 2007. "Intra-household Gender Disparities in Children’s Medical Care before Death in India," IZA Discussion Papers 2586, Institute of Labor Economics (IZA).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:267:y:2020:i:c:s0277953620303658. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.