The Impact of Health Policy Reform on Public Opinion

Health care systems are under considerable strain owing to population aging, fiscal consolidation, migration, increasing inequality, and both Europeanization and globalization. Here, policy-makers face a quandary: how to constrain health care spending but yet satisfy public preferences so as to assure political support for the contribution rates necessary to finance the health care system? Does privatization generate more resources for the public health system? Or does it undermine the public sector by disintegrating social solidarity? This paper examines the relationship between the changing public-private boundary in health care and both satisfaction with the health care system and support for the welfare state in general. Does privatization lead to decreased or increased satisfaction with the health system, and if so, what are the repercussions for public support for the welfare state? Whereas the literature on policy feedbacks and the role of public opinion in welfare state development has focused on macro-indicators for public opinion, in this paper, we argue that individuals’ satisfaction with the health care system, personal needs/risks, as well as partisanship mediate the relationship between social spending and welfare attitudes. We examine the effect of different reforms in health care spending on public satisfaction and welfare state attitudes using European Social Survey from 2002 until 2012 and OECD Health indicators. To test the association between satisfaction with different features of the health care system and welfare attitudes, we rely on a new public opinion survey of our own design, conducted under the auspices of the 2015 German Socio-Economic Panel Study Innovation Sample.