Responding to growing health care costs: Public preferences in four OECD countries

Growing health care cost has been a crucial issue for the governments of advanced democracies. This article analyzes public preferences for reforms surrounding growing health care costs. The main contribution of the study is to analyze how preferences for health reforms vary between the voters of different parties. The study relies on an original survey conducted in four OECD countries representing different types of health care systems: Canada, Germany, Switzerland and the United Kingdom (England). Respondents were asked to choose between the allocation of more resources to the health care system (with higher taxes or contributions or user fees) or cutbacks in curative care or prevention. While all partisan groups oppose cutbacks to curative care, we find substantial partisan polarization in the reform choices between left-wing/green partisans and right-wing partisans. Left-wing partisans prefer higher taxes to avoid cutbacks, whereas right-wing partisans, in particular those of the populist right, prefer cutbacks to health promotion activities to avoid higher taxes. We also find that respondents who are satisfied with health care are more likely to accept increasing taxes or contributions to avoid cuts. We find significantly lower support for the allocation of additional resources to avoid cutbacks in Switzerland, a system characterized by regressive financing, and find stronger partisan polarization in Canada and England. There are clear differences between the supporters of different parties regarding reform options as a response to growing health care costs, particularly regarding higher taxes to avoid cutbacks in prevention and health promotion.