Providers and Politics: The Effect of Private Healthcare on Citizen Trust in Government in Western and Eastern Europe.

How does the private provision of social welfare functions affect citizen attitudes towards the state? In this paper we use a multilevel model and simulations to test whether private social services undermine citizen confidence in state institutions by "hollowing out" the moral legitimacy of the state, or boost trust in government by producing more satisfied citizens who benefit from more effectively delivered services. We find that ceteris paribus, private provision and financing of health services both decrease citizen trust in government in both Western and Eastern Europe. In Western Europe, but not in the East, more intensive users of healthcare are less negatively affected by private provision. These findings lend support to the "hollowing out" thesis, but also suggest that where private services offer greater real or perceived efficiency for a vocal minority of users, they may act as a political counterweight to the equity concerns of the majority. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]