Publication date: Aug 28, 2025
This study examines individual perceptions of national healthcare system efficiency before and after the COVID-19 pandemic across 18 countries grouped into three clusters (the Anglo-world, Europe, East Asia). This paper aims to identify the demographic, socioeconomic, health-related, and macroeconomic healthcare drivers of public assessments, and explain changes in attitudes between 2011-2013 and 2021-2023. Using individual-level data from the International Social Survey Programme (ISSP) for 2011-2013 and 2021-2023, logistic regression models of perceived healthcare inefficiency are estimated. In addition, the Oaxaca-Blinder decomposition model is adopted in order to decompose the assessment gap between the two periods. Models include a range of individual demographic and socioeconomic characteristics and national healthcare controls (healthcare expenditure, potential years of life lost). Health-related factors, especially self-assessed health and trust in doctors, consistently emerge as predictors of more favourable evaluations across regions and periods. Higher national healthcare expenditure is associated with more positive public views and is the single largest contributor to the improved assessments in 2021-2023. Demographic and socioeconomic variables show smaller regionally and temporally heterogeneous effects. Decomposition indicates that both changes in observed characteristics (notably, expenditure and trust) and unobserved behavioural, cultural, or institutional shifts account for the gap in public healthcare assessments between the two time periods. Public assessments of healthcare systems are primarily shaped by individual health status, trust in providers, and national spending rather than differential demographic and socioeconomic traits. Therefore, policymakers should couple targeted investments in the healthcare sector in order to address adequately public healthcare needs, and strengthen doctor-patient relationships in order to sustain public support. Future research should focus on disentangling the cultural and behavioural pathways influencing healthcare attitudes.
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| Concepts | Keywords |
|---|---|
| Healthcare | behavioural traits |
| Heterogeneous | cultural traits |
| Oaxaca | decomposition analysis |
| doctor trust | |
| health spending | |
| healthcare efficiency |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | COVID-19 Pandemic |
| disease | MESH | health status |
| disease | IDO | country |
| drug | DRUGBANK | Coenzyme M |
| disease | MESH | marital status |
| disease | MESH | education level |
| disease | MESH | premature mortality |
| disease | MESH | death |
| disease | IDO | role |
| disease | IDO | quality |
| drug | DRUGBANK | Pentaerythritol tetranitrate |
| disease | MESH | AIDS |
| disease | MESH | causes |
| drug | DRUGBANK | Guanosine |