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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2016

Open Access 01-12-2016 | Research

Are health care inequalities unfair? A study on public attitudes in 23 countries

Authors: Olaf von dem Knesebeck, Nico Vonneilich, Tae Jun Kim

Published in: International Journal for Equity in Health | Issue 1/2016

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Abstract

Background

In this article we focus on the following aims: (1) to analyze national and welfare state variations in the public perception of income-related health care inequalities, (2) to analyze associations of sociodemographic, socioeconomic, health-related, and health care factors with the perception of health care inequalities.

Methods

Data were taken from the International Social Survey Programme (ISSP), an annually repeated cross-sectional survey based on nationally representative samples. 23 countries (N = 37,228) were included and assigned to six welfare states. Attitude towards income-related health care inequalities was assessed by asking: “Is it fair or unfair that people with higher incomes can afford better health care than people with lower incomes?” with response categories ranging from “very fair” (1) to “very unfair” (5). On the individual level, sociodemographic (gender, age), socioeconomic (income, education) health-related (self-rated health), and health care factors (health insurance coverage, financial barriers to health care) were introduced.

Results

About two-thirds of the respondents in all countries think that it is unfair when people with higher incomes can afford better health care than people with lower incomes. Percentages vary between 42.8 in Taiwan and 84 in Slovenia. In terms of welfare states, this proportion is higher in Conservative, South European, and East European regimes than in East Asian, Liberal, and Social-Democratic regimes. Multilevel logistic regression analyses show that women, people affected by a low socioeconomic status, poor health, insufficient insurance coverage, and foregone care are more likely to perceive income-related health care inequalities as unfair.

Conclusions

In most countries a majority of the population perceives income-related health care inequalities as unfair. Large differences between countries were observed. Welfare regime classification is important for explaining the variation across countries.
Literature
1.
2.
Allin S, Grignon M, Le Grand J. Subjective unmet need and utilization of health care services in Canada: What are the equity implications? Soc Sci Med. 2010;70:465–72.CrossRefPubMed
3.
Apouey BH, Geoffard PY. Child health and access to health care in France: evidence on the role of family income. Rev Epidemiol Sante. 2014;62:179–90.CrossRef
4.
Colman E, Symoens S, Bracke P. Professional health care use and subjective unmet need for social or emotional problems: a cross-sectional survey of the married and divorced population of Flanders. BMC Health Serv Res. 2012;12:420.CrossRefPubMedPubMedCentral
5.
Okolo CO, Reidpath DD, Allotey P. Socioeconomic inequalities in access to health care: examining the case of Burkina Faso. J Health Care Poor U. 2011;22:663–82.CrossRef
6.
7.
8.
Mielck A, Kiess R, Knesebeck O, et al. Association between forgone care and household income among the elderly in five Western European countries – analyses based on survey data from the SHARE-study. BMC Health Serv Res. 2009;9:52.CrossRefPubMedPubMedCentral
9.
Reeves A, McKee M, Stuckler D. The attack on universal health coverage in Europe: recession, austerity and unmet needs. Eur J Public Health. 2015;25:364–5.CrossRefPubMedPubMedCentral
10.
Bambra C. Going beyond the three worlds of welfare capitalism: regime theory and public health research. J Epidemiol Community Health. 2007;61:1098–102.CrossRefPubMedPubMedCentral
11.
Dahl E, van der Wel K. Educational inequalities in health in European welfare states: A social expenditure approach. Soc Sci Med. 2013;81:60–9.CrossRefPubMed
12.
Eikemo TA, Bambra C, Joyce K, et al. Welfare state regimes and income-related health inequalities: a comparison of 23 European countries. Eur J Public Health. 2008;18:593–9.CrossRefPubMed
13.
Levecque K, Van Rossem R, De Boyser K, et al. Economic hardship and depression across the life-course: the impact of welfare state regimes. J Health Soc Behav. 2011;52:262–76.CrossRefPubMed
14.
Esping-Andersen G. The three worlds of welfare capitalism. London: Polity; 1990.
15.
Hochmann O, Skopek N. The impact of wealth on subjective well-being: A comparison of three welfare-state regimes. Res Soc Stratif Mobil. 2013;37:127–41.CrossRef
16.
Zambon A, Boyce WF, Currie C, et al. Do welfare regimes mediate the effect of SES on health in adolescence? A cross-national comparison in Europe, North America and Israel. Int J Health Serv. 2006;36:309–29.CrossRefPubMed
17.
Fenger HJM. Welfare regimes in Central and Eastern Europe: incorporating post-communist countries in a welfare regime typology. Contemporary Issues Ideas Soc Sci. 2007;3:1–30.
18.
Ferrera M. The southern model of welfare in social Europe. J Eur Soc Policy. 1996;6:17–37.CrossRef
19.
Abdul Karim S, Eikemo TA, Bambra C. Welfare state regimes and population health: integrating the East Asian welfare states. Health Policy. 2009;94:45–53.CrossRefPubMed
20.
Lee Y-J, Ku Y-W. East Asian welfare regimes: testing the hypothesis of the developmental welfare state. Soc Policy Adm. 2007;41:197–212.CrossRef
21.
Bayerl B, Mielck A. Egalitarian and individualistic perceptions of fairness in health care provision: results from a survey of patients and students. Gesundheitswesen. 2006;68:739–46. in German.CrossRefPubMed
22.
Damm K, Prenzler A, Zuchandke A. Does the perception of fairness and standard of care in the health system depend on the field of study? Results of an empirical analysis. BMC Health Serv Res. 2014;14:166.CrossRefPubMedPubMedCentral
23.
Mollborn S, Stepanikova I, Cook KS. Delayed care and unmet needs among health care system users: when does fiduciary trust in a physician matter? Health Serv Res. 2005;40:1898–917.CrossRefPubMedPubMedCentral
24.
Mohseni M, Lindstrom M. Social capital, trust in the health-care system and self-rated health: the role of access to health care in a population-based study. Soc Sci Med. 2007;64:1373–83.CrossRefPubMed
25.
Hagenaars A, de Vos K, Zaidi MA. Poverty Statistics in the Late 1980s: Research Based on Micro-data. Luxembourg: Office for Official Publications of the European Communities; 1994.
26.
United Nations Educational, Scientific and Cultural Organization. International Standard Classification of Education. Geneva: UNESCO; 1997.
27.
Bodenmann P, Wolff H, Bischoff T, et al. Patients forgoing health care for economic reasons: how to identify this in a primary care setting? Rev Med Suisse. 2014;10:2258–63.PubMed
28.
29.
Jaeger MM. Welfare regimes and attitudes towards redistribution: the regime hypothesis revisited. Eur Sociol Rev. 2006;22:157–70.CrossRef
30.
Van de Velde S, Bambra C, Van der Bracht K, et al. Keeping it in the family: the self-rated health of lone mothers in different European welfare regimes. Sociol Health Illn. 2014;36:1220–42.CrossRefPubMed
31.
Navarro V, Shi L. The political context of social inequalities and health. Soc Sci Med. 2001;52:481–91.CrossRefPubMed
32.
Eikemo TA, Bambra C. The welfare state: a glossary for public health. J Epidemiol Community Health. 2008;62:3–6.CrossRefPubMed
33.
Tavora I. The southern European social model: familialism and the high rates of female employment in Portugal. J Eur Soc Policy. 2012;22:63–76.CrossRef
34.
Rhodes M. Southern European welfare states: identity, problems and prospects for reform. South Eur Soc Polit. 1996;1:1–22.CrossRef
35.
Orenstein MA. Out-liberalizing the EU: pension privatization in Central and Eastern Europe. J Eur Public Policy. 2008;15:899–917.CrossRef
36.
Cavelaars AE, Kunst AE, Geurts JJ, et al. Differences in self-reported morbidity by educational level: a comparison of 11 Western European countries. J Epidemiol Community Health. 1998;52:219–27.
Metadata
Title
Are health care inequalities unfair? A study on public attitudes in 23 countries
Authors
Olaf von dem Knesebeck
Nico Vonneilich
Tae Jun Kim
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-016-0350-8

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