Issue Definition and the Opinion-Policy Link: Public Preferences and Health Care Spending in the US and UK

Abstract

This article explores the extent to which yearly changes in health spending reflect yearly changes in public preferences. Time series modelling suggests that health care spending is remarkably more responsive to yearly changes in public opinion in the US than in the UK. A content analysis of party manifestos suggests the significant role of ‘issue definition’ in accounting for this difference. Health care issues in the US have more often been viewed as problems of expenditure, while UK policy-makers have tended to focus on efficiency. Results suggest that the responsiveness of health care expenditures to public preferences in the US and UK is linked to the way in which health care issues are differently defined by policy-makers.