A Comparison of Eastern and Western European Countries
by Simone Schneider and Tamara Popic

Knowing the public opinion of healthcare is essential when assessing healthcare system performance; but little research has focussed on the links between the public’s general attitude to the healthcare system and its perceptions and expectations of specific healthcare-related aspects. Using data from the fourth round of the European Social Survey 2008/09, we explored whether healthcare evaluations follow a consistent cognitive reasoning. We seek to understand the extent to which evaluations of healthcare services are determined by three cognitive factors: (i) perceptions of the performance of the healthcare system in terms of efficiency, equality, and population health; (ii) expectations of the government’s role in providing healthcare; and (iii) reflections on demographic pressures, i.e. the burden on healthcare of an aging society. Secondly, we investigate the extent to which these cognitive components explain differences in the healthcare evaluations of Eastern and Western Europeans. We found that healthcare evaluations follow a coherent cognitive reasoning. Individuals base their evaluations on their perceptions of the performance of the healthcare system (i.e. efficiency, equality, health outcomes), their expectations of the government’s role in providing healthcare, and their understanding of demographic pressures. While all factors seem relevant, the perception of the efficiency of the system and equality of health treatment are the most important components influencing healthcare evaluations across European countries. Contrary to the general assumption that normative expectations are responsible for differences in healthcare evaluations between Eastern and Western Europe, the results suggest that regional differences are largely due to a more negative perception of the performance of healthcare systems within Eastern Europe. Eastern Europeans are more critical as they perceive their systems as less efficient and more unequal in terms of treatment. To improve the public’s general attitude to the healthcare system, policy makers should pay particular attention to the improvement of healthcare system efficiency without sacrificing equality.

To access the full article, go to doi.org/10.1016/j.healthpol.2017.12.012.