Affiliation:
1. Saeko Kikuzawa is an Associate Professor in the Department of Sociology at Hosei University, Japan. Her current research includes cross-national studies of social attitudes toward government responsibility on health care, and cross-cultural studies of social roles and mental health over the life course. Her recent articles include “Multiple Roles and Mental Health in Cross-Cultural Perspective: Elderly in the United States and Japan” (Journal of Health and Social Behavior).
2. Sigrun Olafsdottir is an Assistant Professor of Sociology at Boston University. Her research integrates theories of political and cultural sociology with medical sociology. Her previous work explored the impact of the welfare state on health in a comparative perspective (Journal of Health and Social Behavior 2007), welfare state variations in public attitudes toward family policies (with Catherine Bolzendahl), and stigma toward mental health problems (with Bernice A. Pescosolido and others). In addition,...
3. Bernice A. Pescosolido is Distinguished Professor of Sociology at Indiana University and founding Director of the Indiana Consortium for Mental Health Services Research. Her work focuses broadly on the interface of community and health care systems. Currently, she is Principal Investigator on a 15-country study of the stigma of mental illness, a set of studies targeting media influence on stigma, and an examination of a decade of change in Americans' views of mental illness.
Abstract
Health care systems worldwide are experiencing similar pressures such as rising cost, aging populations, and increased burden of disease. While policy makers in all countries face these challenges, their responses must consider local pressures, particularly the implicit social contract between the state, medicine, and insurers. We argue that public attitudes provide a window into the social context in which policy decisions are embedded. Using data from the International Social Survey Programme (ISSP), we compare public attitudes toward government involvement in health care in 21 countries, testing the associations between various nationallevel variables (e.g., health care expenditures, aging of population, health care traditions) and public opinions. Specifically, we posit four national-level hypotheses (“health care traditions,” “expenditure crisis,” “demographic crisis,” “changing disease profile crisis”), one individual-level hypothesis (“individual vulnerability”), and two cross-level hypotheses (“cultural socialization” and “health care need”). Our findings indicate that public attitudes cluster around the historical organization of health care, but also relate to current economic and demographic realities. Individuals in countries adopting the “National Health Service Model” (the state directly provides health care but complete state control is absent) or the “Centralized Model” (the state directly provides health care and has much control) are more supportive of government involvement in health care than those in the “Insurance Model” (the state is limited to maintenance of the system) countries. However, citizens in countries currently spending more on health care and having a greater burden of chronic illness are less supportive. Our results cast doubt on arguments that increased cost will result in a questioning of the contract between the state and citizens in the social provision of health care. We end by discussing implications for recent work in political sociology that highlights the importance of public attitudes.
Subject
Public Health, Environmental and Occupational Health,Social Psychology
Cited by
55 articles.
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