Medical Care in the Welfare State: A Cross-National Study of Public Evaluations

Abstract

In this study, we examine public evaluations of government performance in the medical care sector. We develop five theoretical models (Consensus, Disillusionment of Target Groups, Resource Control, Reluctant Middle, and Conditional) based on different explanations of welfare state development and examine them across eight countries (the United States, Great Britain, West Germany, Austria, Switzerland, Finland, Italy, and the Netherlands). No single model adequately predicts wthich individuals most negatively evaluate government performance, but a number of patterns emerge. First, targeted groups (i.e., the needy) rarely give poorer performance evaluations in any country. Second, those groups often identified as bearing a heavier tax burden (e.g., upper socioeconomic and middle-aged groups) are more likely to give negative evaluations in many countries we consider. Third, a nation's reputation as an innovator or laggard in guaranteeing health care influences which models operate and why individuals, similar in social position or attitudes, give different evaluations across countries.