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Measuring attitude toward social health insurance

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Abstract

In order to understand the health care system a country chooses to adopt or the health care reform a country decides to undertake, one must first be able to measure a country’s attitude toward social health insurance. Our primary goal was to develop a construct that allows us to measure this “attitude toward social health insurance”. Using a sample of 724 students from the People’s Republic of China, Germany, and the United States and an initial set of sixteen items, we extract a scale that measures the basic attitude toward social health insurance in the three countries. The scale is internally consistent in each of the three countries. A secondary factor labeled “government responsibility” is marginally consistent for the total sample and for the German sample. German respondents have the most favorable attitude toward social health insurance, followed by China, and then the United States. Chinese respondents have the most favorable attitude toward government responsibility in health insurance. The scale developed here can be used to further investigate and understand which health care system will succeed and which will fail in a given country, which is important from both a political and an economic perspective.

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Notes

  1. Cheung and Chow [12] find that managers in Hong Kong, Taiwan, and China are convergent in collectivism and uncertainty avoidance and that Chinese managers have a high level of power distance.

  2. Compare, http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s3582/200902/39201.htm., accessed on January 12, 2011 [44].

  3. This differs for example from the National Health System (NHS) in the United Kingdom, where the government provides insurance coverage for all citizens.

  4. Compare, http://www.hpm.org/en/Surveys/Emory_University_-_USA/16/Virginia_Takes_Health_Reform_Fight_Through_Courts.html, accessed on January 6, 2011.

  5. In the US, for example, the reformed health care system sparked a discussion of whether businesses would not hire more than fifty employees in order to avoid the provision of health care insurance to their employees.

  6. In Germany, the traditional Diploma is still being pursued but it is phased out by the Bachelor degree. However, 14% of the sample is still Diploma students, while 19% of the German sample is pursuing a Master’s degree.

  7. 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 [13] discovered that results from undergraduate students were not dissimilar from results collected from professional investors.

  8. Difference in proportion tests show p-values of .000 for the difference between each Germany and the US and China and the US for each question.

  9. The difference is significant at the .05 level (p-value = .042).

  10. Although the majority of participants from China and Germany agree with question 5, the difference between the two countries is still statistically significant (p-value = .002).

  11. The difference in proportion between Germany and China is not significant at the .05 level for this question.

  12. Difference in proportion tests reveal p-values of .000 for the difference between each Germany and the US and China and the US for each question.

  13. The differences in proportion between China and US as well as Germany and US are statistically significant at the .01 level.

  14. This is more restrictive than most factor analysis, which typically utilize loadings with .4 or higher. See, for example, Fagenson-Eland et al. [22].

  15. Many articles are available on the relevant cutoff for alpha. In exploratory studies, often an alpha as low as .60 is acceptable, which is the approach we employ here. An alpha of .6 is referred to as “questionable” by George et al. [24], while they deem an alpha of .5 as “poor.”.

  16. The results for the “Freedom of Choice” and “Anti-Institution” factors indicate that there is not very strong support for our third hypothesis. However, we are encouraged that these factors emerged, even though they are not very reliable. We leave it to future research to develop alternative questions to isolate these factors.

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Acknowledgments

We would like to thank our colleagues at the School of International Economics and Trade of Beijing International Studies University (BISU) for their help in administering the surveys in their courses. We would also like to thank Dr. Lakshmi Goel at the University of North Florida, Marcello Rossi from Universidad Austral, and two anonymous reviewers for helpful comments and suggestions.

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Authors and Affiliations

  1. The University of North Florida, Jacksonville, FL, USA

    Chung-Ping A. Loh & Oliver Schnusenberg

  2. Niederrhein University of Applied Sciences, Krefeld, Germany

    Katrin Nihalani

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  1. Chung-Ping A. Loh
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Correspondence to Oliver Schnusenberg.

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Loh, CP.A., Nihalani, K. & Schnusenberg, O. Measuring attitude toward social health insurance. Eur J Health Econ 13, 707–722 (2012). https://doi.org/10.1007/s10198-011-0324-0

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