A bitter aftertaste? The effects of privatisation reforms on evaluations of health systems across Europe

What is the effect of healthcare privatisation on citizens’ views of the health system? Using an original data set of legislative changes in health policy and European Social Survey data on healthcare system evaluation, we analyse the link between healthcare privatisation reforms and citizens’ evaluations of health systems across 30 European countries. Our results show that after an initial positive reaction, privatisation is associated with the worsening of attitudes towards the health system. Partisanship of the government enacting privatisation matters for evaluations, but this effect of partisanship is relatively short-termed. Most importantly, results point to the critical importance of proximity. Privatisation reforms with more direct effects on healthcare use are evaluated more negatively compared with those with indirect effects, demonstrating the importance of policy proximity to beneficiaries. Similarly, an individual’s proximity to policy, which refers to direct exposure to health policy based on health status, has a more immediate and extended effect on evaluations compared to characteristics unrelated to care use, such as ideology. Overall, the results demonstrate that citizens react to privatisation in a dynamic way and discriminate between different types of privatisation reforms, contributing to a better understanding of the individual and the temporal dimension of policy effects.