Are Expectations about Health Care Universal? The International Evidence
Kathryn Simms

Abstract
Evaluating differences in international health care systems has been suggested as an approach for determining which strategies work best. Such an approach, however, is predicated on the assumption that all peoples have similar expectations about health care. This study assessed this assumption by relying on nationally representative samples of about41% the world’s population (i.e., China, Ghana, India, Mexico, the Russian Federation, and South Africa). Participants tended to rank the health care expectations evaluated as being more than moderately important. At the same time, 87 unique statistically significant differences in expectations were detected across country. Analysis indicated that country accounted for only 1 to 8% of variability in expectations—with public versus private/mixed medical financing accounting for from 60% to 96% of county level variability. These findings support the possibility of a tug-of-war between practical and statistical significance in terms of how much country matters in predicting health care expectations.

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