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

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.