The perceived deservingness of COVID-19 healthcare in the Netherlands: a conjoint experiment on priority access to intensive care and vaccination.

BACKGROUND: Amidst the COVID-19 pandemic, governments, health experts, and ethicists have proposed guidelines about ICU triage and priority access to a vaccine. To increase political legitimacy and accountability, public support is important. This study examines what criteria beyond medical need are deemed important to be perceived of priority COVID-19 healthcare access. METHOD: Two conjoint experiments about priority over ICU treatment and early COVID-19 vaccination were implemented in a probability-based sample of 1461 respondents representative of the Netherlands. Respondents were asked who should receive treatment out of two fictitious healthcare claimants that differed in in age, weight, complying with corona policy measures, and occupation, all randomly assigned. Average marginal coefficient effects are estimated to assess the relative importance of the attributes; attributes were interacted with relevant respondent characteristics to find whether consensus exists in this relative ranking. RESULTS: The Dutch penalize those not complying with coronavirus policy measures, and the obese, but prioritize those employed in 'crucial' sectors. For these conditions, there is consensus among the population. For age, young people are prioritized for ICU treatment, while the middle-aged are given priority over a vaccine, with younger respondents favoring healthcare for elderly claimants, while older respondents favor support for young cohorts. CONCLUSION: People who have no control over their social risk and are able to reciprocate to society are considered as more deserving of priority of COVID-19 healthcare. Our findings provide fair support for the implemented ethical guidelines about ICU-treatment and COVID-19 vaccines.

Welfare deservingness opinions from heuristic to measurable concept: The CARIN deservingness principles scale.

A steadily growing number of studies investigate how popular support for social policies targeting particular groups is rooted in citizens' deservingness opinions. According to theory, people fall back on five criteria - Control, Attitude, Reciprocity, Identity and Need (CARIN) - to distinguish the deserving from the undeserving. Deservingness opinions are assumed to be important predictors of support for particular welfare arrangements. A striking feature of this emerging research, however, is that there is no agreed-upon strategy to measure deservingness. Most previous studies rely on proxy-variables rather than measuring the actual deservingness criteria. Deservingness functions as a heuristic rather than as a measured concept, which leads to conceptual confusion. To remedy this shortcoming, this contribution proposes and validates a new instrument -the CARIN deservingness principles scale- that captures the five basic deservingness principles. We analyse data from the Belgian National Election Study by means of structural equation modelling (SEM) to (1) test the dimensionality, validity and reliability of the scale, and (2) verify to what extent the five deservingness principles predict specific policy preferences (as a test of construct validity). Our analyses confirm that the five deservingness principles are distinct dimensions that are differently related to social structural variables and have divergent consequences for policy preferences. The finding of theoretically meaningful patterns of differentiated effects illustrates that the CARIN criteria represent distinct logics of social justice, and corroborates that our measurement instrument is capable of tapping into the essence of these criteria.

The preferred role and perceived performance of the welfare state: European welfare attitudes from a multidimensional perspective.

Welfare state support has two core dimensions: attitudes about what the welfare state should do and beliefs about its actual performance. People can combine any position on one dimension with any position on the other, yielding four opinion clusters: people can combine preferences for a relatively strong role of the welfare state with a perception of a relatively low or high welfare state performance; likewise, people preferring a small role of the welfare state can perceive a high or low performing welfare state. We apply Latent Class Factor Analysis to data of 22 European countries from the 2008/9 European Social Survey. We find that each of the four clusters contains a substantial proportion of respondents that differs between welfare regimes. In addition, cluster membership is also related to covariates that measure people's structural positions and ideological preferences.

The Multidimensionality of Welfare State Attitudes: A European Cross-National Study.

When evaluating the various aspects of the welfare state, people assess some aspects more positively than others. Following a multidimensional approach, this study systematically argues for a framework composed of seven dimensions of the welfare state, which are subject to the opinions of the public. Using confirmatory factor analyses, this conceptual framework of multidimensional welfare attitudes was tested on cross-national data from 22 countries participating in the 2008 European Social Survey. According to our empirical analysis, attitudes towards the welfare state are multidimensional; in general, people are very positive about the welfare state's goals and range, while simultaneously being critical of its efficiency, effectiveness and policy outcomes. We found that these dimensions relate to each other differently in different countries. Eastern/Southern Europeans combine a positive attitude towards the goals and role of government with a more critical attitude towards the welfare state's efficiency and policy outcomes. In contrast, Western/Northern Europeans' attitudes towards the various welfare state dimensions are based partly on a fundamentally positive or negative stance towards the welfare state.