Background: There has been continuous debate in the United States, Germany, and China about their respective healthcare systems. While these three countries are dealing with their own unique problems, the question of how social a healthcare system should be is a topic in this debate. Objective: This study examined how strongly college students' attitudes toward a social healthcare system relate to ideological orientation and self-interest. Methods: We used samples of college students in the People's Republic of China, Germany, and the US, and extracted factors measuring "financial wellbeing," "sociopolitical attitude," "self-interest," and "lifestyle" to explain the "attitude toward social health insurance" (ASHI) construct developed in recent literature (Loh et al. in Eur J Health Econ 13:707-722). Results: The results of regression analysis showed that sociopolitical attitude/progressivism is positively related to the ASHI, but the degree of association varies considerably from country to country. We also found that a self-interest factor, measured by health status, seems to be inversely related to an individual's ASHI in the US, but not in China or Germany. Individuals with relatively healthy lifestyle choices were less likely to have a favorable ASHI in Germany, but no such relationship was found in China and the US. These results indicate that while some commonalities exist, there are also considerable differences in the structure of ASHI across these three countries. Conclusion: Ultimately, the results reported here could help to develop a predictive model that can be utilized to forecast a country's ASHI. Such a predictive model could be used by politicians to gauge the popularity of a healthcare plan that is under consideration in a particular country. © 2013 Springer International Publishing Switzerland.
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