Social Justice Research

, Volume 32, Issue 3, pp 349–383 | Cite as

Risk Exposure, Humanitarianism and Willingness to Pay for Universal Healthcare: A Cross-National Analysis of 28 Countries

  • Luis MaldonadoEmail author
  • Francisco Olivos
  • Juan Carlos Castillo
  • Jorge Atria
  • Ariel Azar


In this article, we explore the associations of people’s valuations of universal healthcare with risk exposure and humanitarianism across diverse institutional contexts. We argue that both micro-level factors increase the valuations. Furthermore, interactions between material interests and humanitarians are expected. This work also hypothesizes that institutional contexts with employment-independent healthcare systems should modify the effect of risk exposure. Following a comparative framework, we test the expectations by using the International Social Survey Programme 2011 health module for 28 developed and developing countries. Results suggest opposite effects for the factors under analysis. While risk exposure decreases the willingness to pay taxes for the provision of universal healthcare, humanitarianism strongly fosters the valuation. Furthermore, we find statistical significant interactions between material interests and humanitarianism. Results also suggest substantive cross-level interactions between risk exposure and healthcare systems. Findings are robust to different modeling strategies that control for standard micro-level variables (income and egalitarianism), individual factors and observed and unobserved country characteristics. The article lays out implications of these findings.


ISSP Public attitude Risk Humanitarianism Cross-national comparisons Institutional contexts 



This project was supported by CONICYT/FONDECYT REGULAR/1160921, CONICYT/POSTDOCTORADO/3160705, CONICYT/FONDAP/15130009, CONICYT/FONDAP/15110017 and UC/VRI INICIO/I1704/2017.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Authors and Affiliations

  1. 1.Instituto de Sociología, Pontificia Universidad Católica de ChileSantiagoChile
  2. 2.National Research Center for Integrated Disaster Risk Management (CIGIDEN)SantiagoChile
  3. 3.The Chinese University of Hong KongShatinHong Kong SAR
  4. 4.Centre for Social Conflict and Cohesion Studies (COES)SantiagoChile
  5. 5.Universidad de ChileSantiagoChile
  6. 6.University of ChicagoChicagoUSA

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