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Citizen Support for Hospital Privatization: A Hierarchical Cross-National Analysis

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Abstract

The movement for a new public management (NPM) holds that citizens will put aside partisan and ideological differences to support more efficient service delivery. Focusing on hospital privatization, a multi-national sample is utilized to investigate this assertion. Generalized hierarchical linear modeling (GHLM) is employed as the method of statistical analysis. The findings with regard to privatizing hospitals reveal that citizens develop their policy position by reference to a combination of symbolic political variables, service demand, self-interest, information levels, and political efficacy. The results cast doubt on the assertion that partisan differences will be set aside as citizens consider privatization reforms.

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Notes

  1. Brickley and Van Horn’s (2002) analysis of CEOs in nonprofit and for-profit hospitals suggests that incentives for managers in both types of organizations tend to focus on financial performance.

  2. The expenditure data are from 1995 as the attitudinal data are from 1996. The expenditure data were obtained from the World Health Organization.

  3. The original collector of the data, ICPSR, and the relevant funding agency bear no responsibility for the uses of this collection or for the interpretations or inferences based upon such uses. Variable coding is presented in the Appendix.

  4. The authors admit that the dichotomous dependent variable does not capture all the complexities and nuances of privatization. For instance, the distribution between “public” and “private” is not always clear-cut with regard to hospitals, nor, indeed, most services affiliated with government or the private sector. Also, the privatization of any health care service, to include hospitals, can assume many forms to include financing, health care provision, management/operations, and health care investment (Maarse 2006). The authors consider the statistical model and dependent variable to be most representative of hospital/health provision. For a rich discussion of the concept of privatization as it relates to health see Maarse (2006).

  5. When those who work for the third sector are estimated separately, there is no significant relationship to preference for privatization.

  6. The principle component matrix is as follows:

    • Total health expenditures (as % of GDP) = 0.996

    • Public health expenditures (as % of GDP) = 0.683

    • Public health expenditures (as percent of total health expenditures) = −0.763

    • Eigenvalue = 2.04 Percentage of variance explained = 67.98

  7. μ 0 is equal to the unmodeled variability in unit j.

  8. Laplace estimates are presented. This technique allows the use of the deviance statistics in Table 2. These statistics ordinarily are not possible with a non-linear model. The reduction in deviance statistic and its chi square significance indicate that the present model is an improvement over a more restricted one. See Raudenbush et al. (2004, ch. 6). Public health spending is grand mean centered.

  9. Results are robust regardless of whether the USA is included in the analysis.

  10. This concern by the educated for the well-being of a nation has been referred to as “democratic enlightenment” (Rahn et al. 1999, 128–129).

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Authors and Affiliations

  1. Public Affairs Program, School of Economic, Political, and Policy Sciences, The University of Texas at Dallas, P.O. Box 830688, WT17, Richardson, TX, 75083-0688, USA

    R. Paul Battaglio Jr.

  2. School of Public and International Affairs, The University of Georgia, 206 Candler Hall, Athens, GA, 30602-1492, USA

    Jerome S. Legge Jr.

Authors
  1. R. Paul Battaglio Jr.
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  2. Jerome S. Legge Jr.
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Correspondence to R. Paul Battaglio Jr..

Appendix: Questions and Variable Coding

Appendix: Questions and Variable Coding

Dependent Variable

Attitude toward Privatization of Hospitals

Explained in text.

Explanatory Variables

Symbolic Variables

Trust in Civil Servants Most civil servants can be trusted to do what is best for the country. 1 = strongly disagree, 2 = disagree, 3 = neither agree or disagree, 4 = agree, 5 = strongly agree.

Party Preference is derived from country specific questions then coded as 1 = far Left (Communists, etc.), 2 = Left, center Left, 3 = center, liberal, 4 = Right, conservative, 5 = far Right, 6 = no specification, 7 = no party or preference. In order to measure the impact of preference on privatization, one variable was created for Left placement. This variable was coded as a dummy with the 1 and 2 codes recoded to “1” and all other values coded “0.” Similarly, a “Right” variable was created from codes 4 and 5. The reference category consisted of codes 3, 6, and 7. Thus, the Left and Right variables were contrasted against centrists and those having no party preference.

Taxes/Spending Tradeoff If the government had a choice between reducing taxes or spending more on social services, which do you think it should do? 0 = reduce taxes, even if this means spending less on social services, 1 = spend more on social services even if this means higher taxes.

Service Demand Variables

Gender 0 = male, 1 = female.

Unemployment 0 = employed, 1 = unemployed.

Age was the age of respondent based on eight categories coded as 1 = up to 17 years, 2 = 18–24 years, 3 = 25–34 years, 4 = 35–44 years, 5 = 45–54 years, 6 = 55–65 years, 7 = 65–74 years, 8 = 75 years or more.

Self-Interest Variables

Public Service Employee/Public Firm Employee (explained in text).

Information/Political Efficacy Variables

Political Information How much do you agree or disagree with the following statements? I think most people are better informed about the important political issues facing the country. 1 = strongly agree, 2 = agree, 3 = neither agree or disagree, 4 = disagree, 5 = strongly disagree.

Education = number of years in school.

Political Efficacy Consisted of a five-point additive scale in which individuals were asked the following questions.

People like me don’t have any say about what the government does. (Item 1)

The average citizen has considerable influence on politics. (Item 2)

Even the best politician cannot have much impact because of the way government works. (Item 3)

Elections are a good way of making governments aware of the important political issues of our country. (Item 4)

The coding was 1 = strongly agree, 2 = agree, 3 = neither agree nor disagree, 4 = disagree, 5 = strongly disagree. Thus, a “5” score indicates a high degree of efficacy for items 1 and 3. The codes were reversed for items 2 and 4.

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Battaglio, R.P., Legge, J.S. Citizen Support for Hospital Privatization: A Hierarchical Cross-National Analysis. Public Organiz Rev 8, 17–36 (2008). https://doi.org/10.1007/s11115-007-0045-0

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