Attitudes toward healthcare performance in Europe, 2002-2017: How absolute and relative measures can reveal different patterns

Citizens' attitudes towards their national healthcare are important indicators of satisfaction and of political perspectives. In this article we summarise individual and national level patterns in healthcare evaluations across Europe. An innovative feature of our analysis is that we demonstrate that assessing healthcare evaluations in relative terms (relative to citizens' views about the performance of national institutions in other domains), offers new insights about individual and national level variations in attitudes. Thus, we introduce an indicator of relative attitudes towards healthcare and contrast it to an absolute measure in a cross-national analysis. We use a larger dataset than previous studies of healthcare evaluations including countries from all regions of Europe and spanning eight rounds of the European Social Survey (2002-2017, N = 342,000). We find that Europeans' healthcare evaluations are multidimensional, with different patterns sometimes operating at an absolute and a relative level. When comparing countries, for instance, several nations in Southern and Eastern Europe compare poorly to other nations in their absolute ratings of healthcare but compare favourably if assessed in relative terms. Likewise, using a relative measure, most Scandinavian countries compare less favourably to other countries, but score positively when evaluations are measured in absolute terms.