An East-West Comparison of Attitudes towards Healthcare Systems in Europe: Do Institutions Matter?

Differences in welfare attitudes of Eastern and Western Europeans have often been explained in terms of legacies of communism. In this article, we explore evaluations of healthcare systems across European countries and argue that East–West differences in these evaluations are explained by differences in the current institutional design of healthcare systems in the two regions. The empirical analysis is based on the fourth round of the European Social Survey, applying multilevel and multilevel mediation analysis. Our results support the institutional explanation. Regional differences in healthcare evaluations are explained by institutional characteristics of the healthcare system, that is, lower financial resources, higher out-of-pocket payments, and lower supply of primary healthcare services in Eastern compared to Western European countries. We conclude that specific aspects of the current institutional design of healthcare systems are crucial for understanding East–West differences in healthcare evaluations and encourage research to further explore the relevance of institutions for differences in welfare state attitudes across socio-political contexts.