SOCIO-ECONOMIC ASPECTS OF HEALTHCARE
individual opinion of electorates of this party towards a party position regarding the proposed programs and policies. Within the domain of public services, citizen satisfaction is affected by the role of party bias - because of party identification - in shaping political perceptions (Tilley and Hobolt 2011; James and Van Ryzin 2017, Jilke 2018, Jilke and Baekgaard 2020). The health care sector is traditionally highly dependent on the political system and changes in government policy, as a significant share of this sector is financed from state or local budgets.
An important question is whether the partisan bias effect has a real impact when it comes to electorates making decisions about issues that are associated with health risk factors, and, sometimes, a risk to their lives. To date, there is a limited number of works that highlight research on studying partisan bias in the field of health care. Most of these works focus mainly on the one- or two-way impact of partisan bias and population health behavior. Although studying this issue is just beginning, the outcomes already obtained need to be analyzed, compared, and comprehended in order to develop meaningfully this research.
These arguments define our object to systematize outcomes of research and scientific concepts in the study of the relationship between the partisan bias, evaluation of health care policies and health behavior of electorates.
Results and discussion. One of the current areas of scientific experimental research is the study of the influence of party affiliation and political views of electorates on the formation of social policies, including the field of health care. The health care sector is traditionally quite dependent on the political system and changes in government policy, as a significant share of enterprises and organizations in these sectors are financed from budget revenues.
Thus, J. Pacheco and J. Fletcher underline that “theorizing about how health is related to political behavior is a formidable task since it requires integrating literatures from political science, sociology, psychology, and public health to generate new theories that link health conditions and risk behaviors to political behavior” [10, p.104].
There are two main groups of studies in the scientific literature on the influence of the political behavior of electorates and their health behavior on each other.
The first group of researches is devoted to the impact of health on political behavior and results of elections and partisan bias of electorates. S. Kailthya, U. Kambhampati focused on causal relationships between political competition and its effects on health outcomes.The explanation of this situation is connected with partisan bias effects when voters don’t have enough information about real internal issues that impact healthcare quality. In this situation voters tend to simplify their decision-making process and evaluate the results of particular party’s or presidents’ activity in public healthcare policy not by internal (less visible), but by external (more visible) criteria [11]. J.
Pacheco provided evidence that electorates “that are disproportionately more representative of healthy citizens are less likely to spend money on health and have less generous Medicaid programs” [12, p 54]. From the other side the author underlined that health level of electorate is tightly connected with its income inequality in conclusion of the article there is a statement that “the political consequences of increasing income inequality are not restricted to the poor, but also the sick” [12, p.55].
So, here is an example of tight connection between health and economic issues that could impact social policy. One more research of J. Pacheco and J. Fletcher was devoted to measurement the impact of health level at voter turnout and partisanship. In this research authors made a conclusion that “people of poor health are not only less likely to participate in politics, but that they also have different partisan attachments.
In short, health appears to be highly relevant to political behavior and the broader political system” [2, p.112]. There are some other scientific studies, that reveal the impact of the health of electorates on the results of their voting, the emergence of the partisan bias effect and shifts in the evaluation health care policies [13-15]. And all authors claim that this impact have been underestimated during long period.
The second group of researches represents the impact of partisan polarization on the health of voters. Thus, the study [16] describes how political polarization impacts physical and mental health. Authors of the study found out that a lot of people that had political views different from their social environment mentioned more days of poor health outcomes. They argue that “political polarization is not only problematic for policymaking and governance; it also appears to affect ordinary citizens in very direct ways, including their health. Polarization may not only be a political challenge; it may also be a public health concern” [16, p. 8]. Another research was conducted by S. S.
Nayak, T. Fraser, C. Panagopoulos, D. P. Aldrich and D. Kim [17]. They studied the mutual influence of health problems and partisan polarization. In this research there was proved that population’s mental health and sleep disorders depend on people's perception of the degree of society polarization in its political views.
A number of studies are devoted to investigation of the impact of political polarization and partisan bias effects on the dynamics and severity of specific types of diseases and health conditions, such as arterial hypertension [18], mental health [19], and an increase in the incidence of COVID-19 [20, 21, 22]. The last one is a new direction of studies that has been formed in recent years as a response to the world pandemic. It explored the influence of partisan bias effects on people's attitudes towards COVID-19 related activities and on their health behavior. M. V. Geana, N.
Rabb, S. Sloman in their work showed the impact of political ideology at preventive behaviors of people concerning COVID-19 in the United States. The research proofed that “political partisanship carries with it deeply rooted attitudes, values, and beliefs.
When a partisan's ideological community commits to some dogma during a crisis, this dogma influences people's attributions of responsibility”[23, p.6]. So, the most important conclusion from this study is that partisan bias effects have very strong reflection even in situations connected with real high risk for health and life. The authors S. Gadarian, S. Goodman, T. Pepinsky conducted a survey based on analysis of individual self-reported behavior, attitudes, and policy preferences in response to COVID-19. They argued that “on the first month of COVID-19 in the US partisanship was the best predictor of differences in behaviors, attitudes, and preferences” of the two polar groups of democrats and republicans [24, p.10].
Conclusions. Thus, the results of the analysis of relevant scientific works have shown that modern research has confirmed the relationships between health of the
population, which is at the same time the electorates, and partisan bias, polarization and election results.
The following can be noted as the main conclusions of the conducted analysis of concepts and outcomes of the current scientific research:
most studies highlight the negative impact of strong party polarization and partisan bias on electorates’ health;
there are trends of insufficient support for medical programs on the part of those groups of electorates who have fewer health problems. On the other hand, there are differences in the health behavior of electorates, which are significant both within different party affiliations and in groups with different income levels. This means that inequalities could arise not only due to differences in income but also to differences in health status if people with poor health are in a minority in election process;
the influence of partisan bias on the health behavior of the population is so significant that it manifests itself even in the presence of a real threat to life. This was especially evident during the COVID-19 pandemic against the backdrop of polar political discussions about preventive measures. Even with the existence of scientific evidence and facts, people have demonstrated motivated reasoning to explain their health behavior during the pandemic.
In connection with the patterns identified above, it should be noted the feasibility of further research related to mutual influence of the partisan bias of the population, health behavior of electorates and approaches to the formation of health care policies.
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