Public attitudes are important in shaping health-care policies and bringing legitimacy to the policymaking process, especially in times of increasing pressures on health care. Health care institutions on turn have on turn an impact on health and longevity of population. The formation of public attitudes toward healthcare has been explained by three broad sets of factors – interests, ideologies and institutions previously, but the relative importance of these factors is poorly understood. The aim of the paper is to investigate the relative importance of self-interest, ideological values and institutional factors associated with public attitudes toward the role of a government in regulating health-care in 29 countries.

Methods

We use European Social Survey (ESS) data. ESS round 4 (2008/2009) was one of the richest in terms of number of countries in the survey. Public attitudes toward government responsibility in healthcare provision was measured with a question “People have different views on what the responsibilities of governments should or should not be to ensure adequate health care for the sick.

Results

Countries differ considerably in their structure of support to government in heath care activities. The most universal is the influence of ideological leaning variables on the attitudes about the role of a government. The U- curve relationship between individual health conditions and public attitudes emerges clearly only in 10 countries out of 29. In these countries interestingly people with the best and worst health support more government actions. Among institutional factors, people in countries with lower expenditures on health care have higher odds for not supporting the role of a government in health-care.

Conclusions

Ideological leaning have the most robust influence on the public attitudes toward the role of government in provision of health-care. Institutional factors and self-interest variables have more limited influence.