Healthy Self-Interest? Health Dependent Preferences for Fairer Health Care

Health status can alter individuals’ social preferences, and specifically individuals' preferences regarding fairness in the access to and financing of health care. If individuals follow a healthy self-interested rationale, health improvements are expected to weaken individuals' support for fairer health care financing and access, as they perceive reduced need for healthcare services. Conversely, if healthier people face a higher opportunity cost of deteriorating health, they may endorse fairer financing and access in anticipation of future health challenges—which we label as the 'unhealthy self-interest' hypothesis. We draw on a dataset of 73,452 individuals across 22 countries and a novel instrumental variable strategy that exploits variation in health status resulting from cross-country exposure to the national childhood Bacillus Calmette–Guérin (BCG) vaccination schedules. We document causal evidence consistent with the unhealthy self-interest hypothesis, which indicates that better health increases preferences for a fairer health care system. We estimate that a one-unit increase in self-reported health increases support for fair health care access by 11% and the willingness to support fair financing by 8%. Our findings suggest that improving population health, they may give rise to stronger support for interventions to improve equitable health system access and financing.