Department of Health Policy London School of Economics and Political Science (LSE), CESIfo & IZA.
University of Murcia, Spain.
Econ Hum Biol. 2023 Apr;49:101235. doi: 10.1016/j.ehb.2023.101235. Epub 2023 Feb 23.
We examine the extent to which exposure to higher relative COVID-19 mortality (RM), influences health system trust (HST), and whether changes in HST explain the perceived ease of compliance with pandemic restrictions during the COVID-19 pandemic. Drawing on evidence from two representative surveys covering all regions of 28 European countries before and after the first COVID-19 wave, and using a difference in differences strategy together with Coarsened Exact Matching (CEM), we document that living in a region with higher RM during the first wave of the pandemic increased HST. However, the positive effect of RM on HST is driven by individuals over 45 years of age, and the opposite effect is found among younger cohorts. Furthemore, we find that a higher HST reduces the costs of complying with COVID-19 restrictions, but only so long as excess mortality does not exceed the average by more than 20%, at which point the ease of complying with COVID-19 restrictions significantly declines, offsetting the positive effect of trust in the healthcare system. Our interpretation of these estimates is that a higher RM is interpreted as a risk signal among those over 45, and as a signal of health-care system failure among younger age individuals.
我们考察了在多大程度上，接触到更高的 COVID-19 相对死亡率（RM）会影响对卫生系统的信任（HST），以及 HST 的变化是否解释了 COVID-19 大流行期间对遵守大流行限制的感知容易程度。本研究利用在 COVID-19 第一波疫情之前和之后覆盖 28 个欧洲国家所有地区的两项具有代表性的调查证据，采用差分法和粗化精确匹配（CEM）策略，我们发现，在第一波疫情期间，生活在 RM 较高地区的人会增加 HST。然而，RM 对 HST 的积极影响是由 45 岁以上的个体驱动的，而在年轻群体中则发现了相反的影响。此外，我们发现，较高的 HST 降低了遵守 COVID-19 限制的成本，但前提是超额死亡率不超过平均水平 20%以上，此时遵守 COVID-19 限制的便利性会显著下降，抵消了对医疗保健系统的信任的积极影响。我们对这些估计的解释是，RM 较高被 45 岁以上的人视为风险信号，而被年轻个体视为医疗保健系统失败的信号。
