Public Health Care in the Balance: Exploring Popular Support for Health Care Systems in the European Union

Health care systems are important elements of western European welfare states. Earlier research indicates that public health care has always been warmly welcomed and supported by the public, even in periods of retreat of the welfare state due to retrenchment policies. Using data from 1973, Ardigó (1995) reviewed comparative evidence on the public opinion concerning health services in seven European countries and the United States. He found that citizens considered good medical care 'very important' and its provision an 'essential' responsibility of the government. Even though the welfare state was said to suffer from a legitimacy crisis from the mid-70's onwards; the results of the survey showed no traces of this crisis. Neither did the results of a profound trend-study on welfare attitudes by Coughlin (1980). Despite a considerable ambivalence among the public towards some programs, his findings clearly showed that some of the most expensive and extensive elements of the welfare state, such as old-age pensions and health care, were invariably popular. Because his findings revealed no evidence of a health care backlash, Coughlin (1980: 74-75) concludes, that even though national approaches to the provision of health care vary in their organisation, coverage, funding and circumstances under which care is provided, public attitudes towards government provision of health care show a surprisingly constant pattern of popularity across nations. Currently, all European Union member states provide or guarantee health care to their populations. In all countries, coverage is nearly 100 percent of the population, except in Germany, the Netherlands, Ireland and Portugal where a part of the population has to rely on private insurance or has to cover the costs themselves. However, as pointed out by TaylorGooby (1996), these health care systems are, in spite of many differences in their set-up, facing common problems: a combination of demographic shifts, technological advances and rising public expectations increasing the costs of provision.