Does Non-State Provision of Social Services Promote or Undermine Citizen Trust in Government? The Case of Health Care in Europe

Abstract

What happens to citizens’ attitudes towards their governments when non-state actors play a prominent role in insuring citizens against the social risks that were once seen as central concerns of the welfare state? When private firms, religious groups, or NGOs provide social goods, governments may be robbed of opportunities to generate public trust. Alternatively, satisfied consumers of private services may come to trust the state more. Using individual-level data from the 2008 European Social Survey and country-level health care financing data we analyze the effects of private financing of health care on political trust in 25 European countries. Net of known predictors of trust at the individual and country level, we find that trust in government is significantly lower among at-risk individuals living in countries where the health system is financed to a greater degree by private sources. This negative relationship between private financing and trust in government is the outcome of a multi-step process in which low-income individuals report greater perceived risk of having unmet health care needs and, in turn, express less satisfaction with the heath care system, particularly in more privatized systems.