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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]

It is well established that speakers accommodate in speech production. Recent work has shown a similar effect in perception—speech perception is affected by a listener’s beliefs about the speaker. In this paper, we explore the consequences of such perceptual accommodation for experiments in speech perception and lexical access. Our interest is whether perceptual accommodation to one speaker—the experimenter who meets participants, for example— might have carry-over effects on participants’ behavior in subsequent tasks that do not directly involve the experimenter’s voice. We explore this possibility by exposing groups of participants to different varieties of English before they participate in experiments involving speech perception and/or lexical access. Our results reveal that the nature of this prior exposure considerably influences participants’ behavior in the tasks.This suggests that the phonetic detail of encountered speech is stored in the lexicon, together with information about the speaker’s regional origin. Subparts of phonetically detailed lexical distributions can then be effectively ‘primed’ by exposure to speakers or lexical items associated with particular dialects. We argue for an exemplar model of lexical representation with both word-level and phoneme-level representations. The consequences of cross-dialectal priming vary, depending on whether tasks involve primarily word-level or phoneme-level access. [ABSTRACT FROM PUBLISHER]