Social context matters: the role of social support and social norms in healthcare solidarity

Abstract Background In many European countries, including the Netherlands, the healthcare system is based upon solidarity. It is important that public support for solidarity-based systems is sufficient, to ensure that people remain willing to contribute to them. Although support is generally high, as indicated by high levels of willingness to pay for the healthcare costs of others, there are differences between groups. Previous research has focused on individual and institutional characteristics when explaining these differences. However, people's social context may also play a role. Little research has been conducted into this. To fill this gap, we examined the role of perceived social support and social norms in order to explain differences in the willingness to pay for other people's healthcare costs. Methods A questionnaire was sent to a representative sample of 1,500 members of the Dutch Healthcare Consumer Panel in November 2021 (56% response rate, N = 837). The relationship between the social context of people and their willingness to pay was studied via logistic regression analysis. Results Higher levels of perceived social support are associated with higher levels of willingness to pay for other people's healthcare costs (p = 0.038). We also found that willingness to pay is higher when someone's social context is more supportive of the solidarity-based healthcare system (p = 0.001). Contrary to our expectations, the effect of social norms does not differ between people who perceive low and high levels of socials support. Conclusions The degree to which people feel connected to others and the degree to which someone's social context supports the solidarity-based healthcare system affect the willingness to contribute to the healthcare system. Our results suggest that the social context of people has to be taken into account in both policy and research that addresses healthcare solidarity, next to individual and institutional characteristics. Key messages • Social support and social norms play a role in the willingness to pay for healthcare costs of others. • People's social context must be taken into account in policy and research on healthcare solidarity.


Background:
In many European countries, including the Netherlands, the healthcare system is based upon solidarity. It is important that public support for solidarity-based systems is sufficient, to ensure that people remain willing to contribute to them. Although support is generally high, as indicated by high levels of willingness to pay for the healthcare costs of others, there are differences between groups. Previous research has focused on individual and institutional characteristics when explaining these differences. However, people's social context may also play a role. Little research has been conducted into this. To fill this gap, we examined the role of perceived social support and social norms in order to explain differences in the willingness to pay for other people's healthcare costs.

Methods:
A questionnaire was sent to a representative sample of 1,500 members of the Dutch Healthcare Consumer Panel in November 2021 (56% response rate, N = 837). The relationship between the social context of people and their willingness to pay was studied via logistic regression analysis.

Results:
Higher levels of perceived social support are associated with higher levels of willingness to pay for other people's healthcare costs (p = 0.038). We also found that willingness to pay is higher when someone's social context is more supportive of the solidarity-based healthcare system (p = 0.001). Contrary to our expectations, the effect of social norms does not differ between people who perceive low and high levels of socials support.

Conclusions:
The degree to which people feel connected to others and the degree to which someone's social context supports the solidarity-based healthcare system affect the willingness to contribute to the healthcare system. Our results suggest that the social context of people has to be taken into account in both policy and research that addresses healthcare solidarity, next to individual and institutional characteristics. Key messages: Social support and social norms play a role in the willingness to pay for healthcare costs of others. People's social context must be taken into account in policy and research on healthcare solidarity.

Background:
The adoption of new and expensive technologies is one of the main causes of the growing expenditure on health. Regulators are concerned that health care providers purchase (and use) imaging technologies in quantities that exceed the need, increasing expenditure with little value. We review how countries regulate the purchase and use of imaging technologies.

Methods:
Qualitative. We collected data using a questionnaire completed by researchers from 17 high-income countries purposefully selected based on variation of policies. We built and compared case studies.

Results:
Eleven of the 17 countries analyzed have clear criteria for planning and purchasing imaging technologies. Countries plan different areas, such as supply of specialist care, hospitals by level and type of services, quantity or type of equipment, as well as expenditure on health services and resource allocation. Most countries combine three mechanisms that manage the purchase or use of imaging technologies: (1) seven countries regulate by requiring certificates of need, licenses, or purchase approvals; others regulate by directly limiting the amounts, types and quality of technologies.
(2) All countries use financial tools such as activity-based payment, limited and conditional budgets, and caps on income or volume of services.
(3) Nine countries centralize purchase by a government agency. The literature provides inconclusive evidence regarding the impact of these mechanisms on expenditure on health and access to imaging services.

Conclusions:
Planning the imaging technologies market with clear criteria is essential to avoid abuse. Most countries combine the three mechanisms (regulation, financial tools, centralized purchase). Financial tools are more common and effective. Countries with single payers implement more regulation than countries with multiple, competing, payers. In the later, regulated competition seems to replace regulation. There is a trend of adopting centralized procurement.