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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]

Through a qualitative comparison study of the hiring of the descendants of immigrants for public service jobs in France and in the Netherlands, this article highlights the selection mechanisms implemented by local human resources personnel in the local government in two small towns, one in the Netherlands and one in France. We observed how the respective recruitment politics were designed to improve the visibility and presence of the descendants of migrants in local public services. Our results demonstrate that these two localities use very different methods to recruit the descendants of immigrants: French local authorities used "invisible quotas", and Dutch local authorities used "reversed quotas." They followed two different accounting systems, which in turn had diverse effects on the redefinition of the desired skillset. [ABSTRACT FROM AUTHOR]