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

Olaf Von Dem Knesebeck,Nico Vonneilich,Tae Jun Kim

doi:10.1186/s12939-016-0350-8

Abstract

BackgroundIn 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.MethodsData 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.ResultsAbout 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.ConclusionsIn 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.

Highlights

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 perceptions of health care inequalities
Findings of the multilevel analyses indicate that the welfare regime classification is important for explaining the variation in attitudes towards health care inequalities across countries
Our results 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

Summary

Introduction

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. Social inequalities in access to health services evolve if persons with a higher socioeconomic status (SES) are more likely to receive medical care, compared to those with a lower SES when the same need is given [1, 2]. Income was found to constitute a major determinant of access to health services, since it is associated with the risk to delay or forgo needed medical care [3,4,5]. In terms of international comparisons, the importance of welfare state arrangements as a determinant of health and health care was highlighted in a number of studies [10,11,12,13]. As such, Esping von dem Knesebeck et al International Journal for Equity in Health (2016) 15:61

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