Beyond endogeneity in analyses of public opinion: Evaluations of healthcare by the foreign born across 24 European countries

To address the problem of endogeneity in public opinion research, this study examines the opinions of healthcare held by the foreign born, i.e. those not socialized in the system they are asked to evaluate. It (a) explores the degree to which the healthcare ratings of the foreign born depend on the country’s institutional healthcare setting; (b) stresses the importance of referential standards and the significance of knowledge and previous experiences of healthcare services in the country of origin; and (c) investigates differences in healthcare ratings with the length of time foreign born spent in the destination country. This study uses data from the seven rounds of the European Social Survey (2002–2014) and applies multilevel modelling techniques. Results show the institutional characteristics of healthcare services in the country of residence are associated with healthcare evaluations of the foreign born, in particular if these services are compared to those in the country of origin: the better healthcare institutions perform relative to those in the country of origin, the higher the healthcare ratings. Although comparisons with the country of origin seem relevant to all foreign born, they are sometimes more important to recent arrivals. This study suggests knowledge and experience of different healthcare institutions change perspectives and evaluations of healthcare. This finding enriches the discussion of the effects of socialisation and adaptation processes in the formation of public opinion.