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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]

This article presents information on the Luxembourg Income Study (LIS) data in analysing the levels and trends of income inequality in five countries. Inequality increased in Sweden, Great Britain and the United States but did not increase in Canada and the Netherlands. Increased inequality of household head's earnings and increased shares of spouse's earnings in family income account for much of the observed increases in income inequality. The public sector can, in general, be assigned a moderating effect on these changes. Demographic shifts are not assigned any major role in inequality changes. The two distinctive features of this paper are that it examines the trends in inequality in disposable income among the whole population in the five countries using comparable data, and it examines which broad sets of explanations are and which are not compatible with the observations, using a unified framework.