Egalitarian and individualistic perceptions of fairness in health care provision: Results from a survey of patients and students

objective: This study focuses on the following question: How are health care reform proposals accepted by different groups of insured persons? Two perceptions of justice or fairness are compared. The "egalitarian view" states that the financial burden should be distributed as equally as possible across all insured persons and that health care should be offered to all insured persons in the same way. The "individualistic view" states that health care should be provided according to the individual's willingness to pay for it, and also according to the individual health behaviour. Methods: In 2003, a standardised questionnaire was answered by a random sample of 343 persons (175 elderly patients and 168 students). The egalitarian view was assessed by four questions and the individualistic view by five questions. The questionnaire included vignettes. Based on this method it is possible to assess if an answer depends on the "frame" that is presented as an example (framing the question as: thinking of a poor or a wealthy person). Results: A bivariate analyses show that the egalitarian view is mostly present in the following groups of patients: higher age group, insured in a Statutory Sickness fund, high medication, many physician visits. Concerning students, this view is also associated with low physical activity. The individualistic view can be found mostly in the following groups of patients: male, insured in a private health insurance, higher educational level, employed, high physical activity, non-smoker. Concerning students, very similar associations can be seen. These results are largely confirmed by multivariate analyses. It can also be seen that the answers are strongly influenced by the vignettes. Discussion: The insured persons seem to approve or disapprove of health care reform proposals according to their personal characteristics. The overall acceptance of health care reforms will largely depend on the ability to integrate these different perspectives.