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Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

Companies face challenges and need support when applying specific knowledge to their innovation processes, such as design for sustainability. The providers of innovation support in innovation systems are intermediaries. While the literature on intermediaries focuses on various roles and approaches, the way in which intermediaries function in specific fields such as design for sustainability remains underexplored. This paper investigates how intermediaries provide innovation support in the design for sustainability field today, with a focus on the services and support they offer, the approaches and drivers that shape them, as well as the challenges of the intermediation process, particularly concerning sustainability and design. To do this, 14 intermediaries from the Netherlands, the United Kingdom and Turkey were investigated through case studies. The role of design in support processes, especially during implementation, the importance and types of collaborations among various actors of innovation systems, and the emergence of a new type of intermediary that promises radical innovation in sustainability are among the findings. In addition, based on the empirical data, we suggest a framework for describing the roles and attributes of a group of five intermediaries that meets the needs of all types of companies engaged in design for sustainability. Finally we offer suggestions for Turkey on how to raise the capacity of its intermediaries operating in the design for sustainability field, which might be applicable to other similar contexts as well. This study contributes to the theory and practice of innovation support in the sustainability field, from which all innovation system's actors, especially intermediaries and governmental institutions, might benefit in designing support programs. [ABSTRACT FROM AUTHOR]