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The Role of Financial Wellbeing, Sociopolitical Attitude, Self-Interest, and Lifestyle in One’s Attitude Toward Social Health Insurance

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Abstract

Background

There has been continuous debate in the United States, Germany, and China about their respective healthcare systems. While these three countries are dealing with their own unique problems, the question of how social a healthcare system should be is a topic in this debate.

Objective

This study examined how strongly college students’ attitudes toward a social healthcare system relate to ideological orientation and self-interest.

Methods

We used samples of college students in the People’s Republic of China, Germany, and the US, and extracted factors measuring “financial wellbeing,” “sociopolitical attitude,” “self-interest,” and “lifestyle” to explain the “attitude toward social health insurance” (ASHI) construct developed in recent literature (Loh et al. in Eur J Health Econ 13:707–722).

Results

The results of regression analysis showed that sociopolitical attitude/progressivism is positively related to the ASHI, but the degree of association varies considerably from country to country. We also found that a self-interest factor, measured by health status, seems to be inversely related to an individual’s ASHI in the US, but not in China or Germany. Individuals with relatively healthy lifestyle choices were less likely to have a favorable ASHI in Germany, but no such relationship was found in China and the US. These results indicate that while some commonalities exist, there are also considerable differences in the structure of ASHI across these three countries.

Conclusion

Ultimately, the results reported here could help to develop a predictive model that can be utilized to forecast a country’s ASHI. Such a predictive model could be used by politicians to gauge the popularity of a healthcare plan that is under consideration in a particular country.

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Notes

  1. In 2008, 87.1 % of Chinese residents were covered by some form of health insurance.

  2. The data used in the study is based on a set of questions similar to those used in Loh et al. [1] and in the current study.

  3. Public opinions differ substantially, because individuals differ substantially in their attention and their exposure to elite sources of information [38].

  4. The second question was taken from the Political Typology Quiz at the Pew Research Center website [39].

  5. We started with a larger initial set of questions that was reviewed by two Chinese professors. Both professors eliminated most of the questions and argued that they would not be very useful in truly identifying the sociopolitical attitude of Chinese individuals. The third question was taken from the Political Typology Quiz at the Pew Research Center [39].

  6. This is more restrictive than most factor analysis, which typically utilize loadings with 0.4 or higher [40].

  7. White’s general test confirms the existence of heteroscedasticity.

  8. We acknowledge that the selected sample of students may not be representative of the total student population of each country. However, we believe the universities from which the samples were collected are mid-level universities and therefore represent “average” students in each of the countries.

  9. In Germany, the traditional diploma is still pursued but is being phased out by the bachelor degree. However, 14 % of the sample was still Diploma students, while 19 % of the German sample were pursuing a masters degree. The remaining students were Ph.D. students.

  10. One criticism of the present study could be that student samples are utilized. However, there is evidence that results from students can be extended to a broader population. For example, Cipriani and Guarino [42] discovered that results from undergraduate students were not dissimilar from results collected from professional investors. Perhaps equally important is the fact that the Chinese students were highly educated and had just obtained voting rights. Arguably, this is an important group to attract.

  11. In Germany, the difference in proportions for the second question is not statistically significant at conventional levels. Unless indicated otherwise, all other differences noted here are significant at least at the 10 % level.

  12. Many articles are available on the relevant cutoff for alpha. In exploratory studies, often an alpha as low as 0.60 is acceptable, which is the approach we employ here. An alpha of 0.6 is referred to as “questionable” by George and Mallery [43], while they deem an alpha of 0.5 as “poor.”

  13. We note that the results reported in Table 4 are not identical to the results reported in Table 3 of Loh et al. [1]. This is because the additional questions used to extract the additional factors examined here resulted in additional missing observations. Please also note that our sample size of 612 students is smaller than the sample size of 724 in Loh et al. [1] because of this.

  14. These findings were also reported by Loh et al. [1].

  15. Given the poor alpha of the lifestyle factor, we also repeated the models, this time excluding the lifestyle variable and its interaction terms. The results were almost identical (the only difference was that the Germany coefficient in Model 2 becomes negative and significant) and are available from the authors upon request.

  16. An exception is the long-time existence of Medicare. But we do not expect the young sample in this study have much experience with the system.

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Acknowledgments

The authors thank the survey participants for completing the surveys, and acknowledge the various faculty members that helped in administering the survey in the three countries.

Author contribution

All three authors contributed equally to the article. Oliver Schnusenberg is the guarantor for the overall content. None of the authors have any conflicts of interest, and none of the authors received any external funding to complete this manuscript.

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Authors and Affiliations

  1. Department of Accounting and Finance, The University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA

    Oliver Schnusenberg

  2. The University of North Florida, Jacksonville, USA

    Chung-Ping A. Loh

  3. University of Applied Sciences Niederrhein, Krefeld, Germany

    Katrin Nihalani

Authors
  1. Oliver Schnusenberg
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  2. Chung-Ping A. Loh
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  3. Katrin Nihalani
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Corresponding author

Correspondence to Oliver Schnusenberg.

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Schnusenberg, O., Loh, CP.A. & Nihalani, K. The Role of Financial Wellbeing, Sociopolitical Attitude, Self-Interest, and Lifestyle in One’s Attitude Toward Social Health Insurance. Appl Health Econ Health Policy 11, 369–381 (2013). https://doi.org/10.1007/s40258-013-0036-y

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