Successful Health Care Systems? Public Evaluations of Health Systems and the Link to Health Inequalities

Health care systems vary across multiple domains, including financing, delivery of services and access. While it is possible to evaluate health care systems in different ways, one of the most important aspect is how users of services evaluate their health care system and whether they consider their health needs to be met in satisfactory manner. As all citizens in a country are past, or at least potential users of services, we argue that public attitudes provide an important window into the general cultural climate of satisfaction, or lack therefore, with the health care system. Using data from the 2011 International Social Survey Programme (ISSP), we ask: 1) whether there are cross-national differences in public satisfaction with the health care system; 2) whether evaluations are shaped by social fault lines within and across nations; and 3) whether public evaluation of health care systems are linked to health and health inequalities. The ISSP includes countries from all continents that vary greatly regarding level of development and the social organization of health care. Consequently, our paper provides a global view of public satisfaction with health care systems and how these ratings are related to health and health inequalities. The findings increase our understanding of what kind of health care systems are likely to produce general satisfaction among citizens and whether health care arrangements that get such reviews tend to be better for the health of all citizens and/or citizens that may be particularly vulnerable due to their position in the stratification system.