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The Influence of Private Health Care Financing on Citizen Trust in Government

Published online by Cambridge University Press:  15 December 2015


Using individual-level data from the 2008 European Social Survey and country-level health care financing data we analyze the influence of private financing of health care on political trust in twenty-five European countries. Net of known predictors of trust at the individual and country level, we find that trust in government is significantly lower where the health system is financed to a greater degree by private sources. This negative relationship occurs because in countries with more private financing, low-income citizens perceive themselves to be at greater risk for not receiving needed health care. This perception of risk is associated with more negative evaluations of the performance of the health care system, which in turn is associated with less trust in government. When states do less to ensure the basic health care needs of members of society who are at greatest risk, these citizens may come to place less trust in government institutions. Hence, the increasing pressure on European governments to privatize the financing of health care in the wake of the financial crisis that is also characterized by growing income inequality threatens to make citizens trust government less. At the same time, implementation of the Affordable Care Act could signal a renaissance for political trust in the United States, if a growing role in the health care system is accompanied by a redistribution of risk.

Copyright © American Political Science Association 2015 

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Funding for this research has been graciously provided by the Christopher H. Browne Center for International Politics at the University of Pennsylvania, and the Political Science Department at Brown University. We are indebted to Kim Tae Kuen for his expertise and research assistance during the an initial phase of data analysis, and to Kelly Bay for her work earlier in the project. Justin Markovits, Benjamin Mishkin, and Samira Thomas also provided valuable assistance in earlier phases of data collection. We would like to thank Heinz Rothgang and Achim Schmid for agreeing to share their pre-publication data on private provision with us; and Giovanni Capoccia, Tulia Falleti, Horacio Larreguy, Evan Lieberman, and Daniel Ziblatt and participants at seminars at Harvard University and the University of Pennsylvania for their helpful feedback. All errors are our own.


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