Abstract
This article investigates the political legitimacy of the health care system and the effects of austerity on the population’s welfare, paying particular attention to Portugal, a country severely harmed by the economic crisis. Based on analysis of data collected from the European Social Survey on 14,988 individuals living in private households during the years between 2002 and 2018, the findings of this study aim to analyze the social and political perception of citizens on the state of health services in two distinctive periods—before and after the economic crisis, according to self-interest, ideological preferences, and institutional setup as predictors of the satisfaction with the health system. The results demonstrate a negative attitude towards the health system over the years, a consistent drop during the financial crisis period, and a rapid recovery afterward. The research also shows that healthcare evaluations depend on the perceived institutional effectiveness in the citizenry’s eyes. The more the citizens perceive the government as effective and trust-worthy, the more they are satisfied with the health system. Also, differences in healthcare evaluations among social groups were felt unequally: while vulnerable citizens were more affected by the Government’s plan of austerity measures for health reform, healthcare evaluations of better-off social groups—younger individuals, those with higher incomes, higher education, and better health status—did not decline. This study contributes to the academic debate on the effects of austerity on the population’s welfare attitudes and highlights the need to examine the different impacts of reforms introduced by the crisis on social groups.
Highlights
The study of popular support to healthcare has long been a critical feature of the welfare states and has increasingly become the subject matter of empirical research on opinions, values, and attitudes [1,2,3,4]
The self-interest approach rests on the assumption that citizens support healthcare because they benefit from access to public health and have health services provided by the State
Age had a positive impact on the perception of evaluation of the healthcare system for the strata 2002–2010
Summary
The study of popular support to healthcare has long been a critical feature of the welfare states and has increasingly become the subject matter of empirical research on opinions, values, and attitudes [1,2,3,4]. The empirical literature provides ample evidence that public health has always been welcomed and supported, showing a recurrent pattern of popularity across nations, even in periods of welfare state retrenchment [5,6,7,8,9]. These differences raise the question of what makes individuals be satisfied with the health care system over time? The self-interest approach rests on the assumption that citizens support healthcare because they benefit from access to public health and have health services provided by the State. As explained by Rothstein and Steinmo [13], citizens pay attention to the procedures they experience when interacting with the National Health
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