Satisfaction with Health Care Systems

Abstract

Apart from the market and the family, welfare state institutions undoubtedly have a major impact on the living conditions of individuals and social groups. As a matter of fact, welfare state institutions can be differently organized and geared towards different goals (e.g. supplementing vs. replacing markets, equality vs. security, minimum standards vs. optimal standards), and hence are likely to have different consequences. The focus of this article, however, is not directly on measuring the impact of welfare state programs on living conditions, but rather on the subjective perception of social security as well as on the acceptance of welfare state institutions. “Quality of life” has been conceptualized by Zapf (1984) as the combination of objective living conditions and subjective well-being, thereby distinguishing various welfare constellations. In a similar vein, we regard subjective social security as an element of the quality of life, and ask for the degree of correspondence between particular institutional arrangements of providing social security and citizens’ satisfaction with the performance of these institutions. The area of health care policy is taken as an example, but the general methodology could be applied to other fields of social policy as well. Based on objective health system indicators from Oecd sources and Eurobarometer survey data, patterns of satisfaction with health care systems are explored cross-nationally. Welfare state regime types, level of health expenditure and “real” level of health services are taken into account as potential determinants. The findings basically point to the importance of institutional characteristics, almost regardless of the level of health expenditure. Since the analysis allows to evaluate the “success” of national health care systems to find popular satisfaction and approval, it may yield important clues for social policy reform.