title: Are health care inequalities unfair? A study on public attitudes in 23 countries.
abstract: BACKGROUND
  In this article we focus on the following aims: (1) to analyze national and welfare state variations in the public perception of income-related health care inequalities, (2) to analyze associations of sociodemographic, socioeconomic, health-related, and health care factors with the perception of health care inequalities.
  
  
  METHODS
  Data were taken from the International Social Survey Programme (ISSP), an annually repeated cross-sectional survey based on nationally representative samples. 23 countries (N = 37,228) were included and assigned to six welfare states. Attitude towards income-related health care inequalities was assessed by asking: "Is it fair or unfair that people with higher incomes can afford better health care than people with lower incomes?" with response categories ranging from "very fair" (1) to "very unfair" (5). On the individual level, sociodemographic (gender, age), socioeconomic (income, education) health-related (self-rated health), and health care factors (health insurance coverage, financial barriers to health care) were introduced.
  
  
  RESULTS
  About two-thirds of the respondents in all countries think that it is unfair when people with higher incomes can afford better health care than people with lower incomes. Percentages vary between 42.8 in Taiwan and 84 in Slovenia. In terms of welfare states, this proportion is higher in Conservative, South European, and East European regimes than in East Asian, Liberal, and Social-Democratic regimes. Multilevel logistic regression analyses show that women, people affected by a low socioeconomic status, poor health, insufficient insurance coverage, and foregone care are more likely to perceive income-related health care inequalities as unfair.
  
  
  CONCLUSIONS
  In most countries a majority of the population perceives income-related health care inequalities as unfair. Large differences between countries were observed. Welfare regime classification is important for explaining the variation across countries.
authors.affiliation: Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. o.knesebeck@uke.uni-hamburg.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: von dem Knesebeck
authors.affiliation: Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Vonneilich
authors.affiliation: Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Kim
mesh_terms: D001290:Attitude; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics* / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010465:Perception; D011639:Public Opinion; D012959:Socioeconomic Factors
keywords: Health care inequalities; International Social Survey Programme; International comparison; Perception of unfairness; Public attitudes; Welfare states