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The popular legitimacy of European healthcare systems: a multilevel analysis of 24 countries

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Abstract
This paper provides an empirical study of the between-individual and between-country differences in the popular legitimacy of European health care systems. In order to explain two dimensions of popular legitimacy (satisfaction and support for state responsibility), we assess the impact of self interest motives (income and personal health), ideology (egalitarianism) and institutional arrangements (level of service provision, and private and government health expenditure). For this purpose, data from the European Social Survey round 4 (ESS-4, 2008-2009) is analysed by means of multilevel models. Universal high support for state responsibility is found, while satisfaction varies considerably, with particularly low levels found in Eastern European and former Soviet Union countries. It appears that individuals are not guided by self-interest motives and ideology alone. In addition to these factors operating in interaction, the results suggest that state-provided health care might be in the interest of all. Introducing a patient perspective could advance our understanding of health care legitimacy.
Keywords
SELF-RATED HEALTH, PATIENT SATISFACTION, WELFARE-STATE, MEDICAL-CARE, MORTALITY, DETERMINANTS, INEQUALITIES, PROVISION, SUPPORT, UNION, health care systems, Europe, popular legitimacy, ideology, self-interest

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MLA
Missinne, Sarah, et al. “The Popular Legitimacy of European Healthcare Systems: A Multilevel Analysis of 24 Countries.” JOURNAL OF EUROPEAN SOCIAL POLICY, vol. 23, no. 3, 2013, pp. 231–47, doi:10.1177/0958928713480065.
APA
Missinne, S., Meuleman, B., & Bracke, P. (2013). The popular legitimacy of European healthcare systems: a multilevel analysis of 24 countries. JOURNAL OF EUROPEAN SOCIAL POLICY, 23(3), 231–247. https://doi.org/10.1177/0958928713480065
Chicago author-date
Missinne, Sarah, Bart Meuleman, and Piet Bracke. 2013. “The Popular Legitimacy of European Healthcare Systems: A Multilevel Analysis of 24 Countries.” JOURNAL OF EUROPEAN SOCIAL POLICY 23 (3): 231–47. https://doi.org/10.1177/0958928713480065.
Chicago author-date (all authors)
Missinne, Sarah, Bart Meuleman, and Piet Bracke. 2013. “The Popular Legitimacy of European Healthcare Systems: A Multilevel Analysis of 24 Countries.” JOURNAL OF EUROPEAN SOCIAL POLICY 23 (3): 231–247. doi:10.1177/0958928713480065.
Vancouver
1.
Missinne S, Meuleman B, Bracke P. The popular legitimacy of European healthcare systems: a multilevel analysis of 24 countries. JOURNAL OF EUROPEAN SOCIAL POLICY. 2013;23(3):231–47.
IEEE
[1]
S. Missinne, B. Meuleman, and P. Bracke, “The popular legitimacy of European healthcare systems: a multilevel analysis of 24 countries,” JOURNAL OF EUROPEAN SOCIAL POLICY, vol. 23, no. 3, pp. 231–247, 2013.
@article{4127541,
  abstract     = {{This paper provides an empirical study of the between-individual and between-country differences in the popular legitimacy of European health care systems. In order to explain two dimensions of popular legitimacy (satisfaction and support for state responsibility), we assess the impact of self interest motives (income and personal health), ideology (egalitarianism) and institutional arrangements (level of service provision, and private and government health expenditure). For this purpose, data from the European Social Survey round 4 (ESS-4, 2008-2009) is analysed by means of multilevel models. Universal high support for state responsibility is found, while satisfaction varies considerably, with particularly low levels found in Eastern European and former Soviet Union countries. It appears that individuals are not guided by self-interest motives and ideology alone. In addition to these factors operating in interaction, the results suggest that state-provided health care might be in the interest of all. Introducing a patient perspective could advance our understanding of health care legitimacy.}},
  author       = {{Missinne, Sarah and Meuleman, Bart and Bracke, Piet}},
  issn         = {{0958-9287}},
  journal      = {{JOURNAL OF EUROPEAN SOCIAL POLICY}},
  keywords     = {{SELF-RATED HEALTH,PATIENT SATISFACTION,WELFARE-STATE,MEDICAL-CARE,MORTALITY,DETERMINANTS,INEQUALITIES,PROVISION,SUPPORT,UNION,health care systems,Europe,popular legitimacy,ideology,self-interest}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{231--247}},
  title        = {{The popular legitimacy of European healthcare systems: a multilevel analysis of 24 countries}},
  url          = {{http://dx.doi.org/10.1177/0958928713480065}},
  volume       = {{23}},
  year         = {{2013}},
}

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