This article investigates to what extent austerity-oriented measures introduced in the Portuguese health sector during the recent economic crisis were associated with changes in the public opinion on healthcare. We conducted multivariate regression analyses of cross-sectional, biannual data from the European Social Survey (2002–2015) for 13,271 individuals living in private households in Portugal. In line with our expectations, healthcare evaluations of the general population improved until 2010 but declined with the implementation of comprehensive austerity measures introduced under the Memorandum of Understanding after 2011. Healthcare evaluations of vulnerable social groups – older and retired individuals, individuals with poor health, low income and education – declined particularly strongly. In addition, differences in healthcare evaluations between more and less vulnerable social groups were more pronounced after 2011. Interestingly, healthcare evaluations of the general population and of some of the most vulnerable groups ‘recovered’ in 2015, when most of the Memorandum measures were implemented. Our findings contribute to the literature on the effects of austerity measures on welfare attitudes and stress the need to analyse the differential impact of crisis-induced welfare state reforms across social groups.

As a result of the recent economic crisis, in 2011, Portugal signed a Memorandum of Understanding with the European Central Bank, the European Commission, and the International Monetary Fund (the “Troika”). In exchange for Troika's financial assistance, the Memorandum required the implementation of a specific set of reforms targeted at the healthcare sector. The literature on policy reforms in the context of crisis and conditionality argues that governments have restricted room to manoeuver in responding to external pressure. We challenge this view, finding that even in cases of conditionality and strong external pressures, crisis can be used as a window of opportunity for reforms substantially shaped by domestic policy choices. In the case of Portuguese health reforms, these choices were based on pre‐existing reform plans aimed on resolving country‐specific deficiencies of the healthcare system and were enabled by the two main political parties' strategies of tacit cooperation and blame avoidance. The article emphasizes the need for more fine‐grained analysis of welfare reforms in the crisis that pays equal attention to the institutional characteristics and the political context of the affected countries.

This article investigates the political legitimacy of the health care system and the effects of austerity on the population’s welfare, paying particular attention to Portugal, a country severely harmed by the economic crisis. Based on analysis of data collected from the European Social Survey on 14,988 individuals living in private households during the years between 2002 and 2018, the findings of this study aim to analyze the social and political perception of citizens on the state of health services in two distinctive periods—before and after the economic crisis, according to self-interest, ideological preferences, and institutional setup as predictors of the satisfaction with the health system. The results demonstrate a negative attitude towards the health system over the years, a consistent drop during the financial crisis period, and a rapid recovery afterward. The research also shows that healthcare evaluations depend on the perceived institutional effectiveness in the citizenry’s eyes. The more the citizens perceive the government as effective and trust-worthy, the more they are satisfied with the health system. Also, differences in healthcare evaluations among social groups were felt unequally: while vulnerable citizens were more affected by the Government’s plan of austerity measures for health reform, healthcare evaluations of better-off social groups—younger individuals, those with higher incomes, higher education, and better health status—did not decline. This study contributes to the academic debate on the effects of austerity on the population’s welfare attitudes and highlights the need to examine the different impacts of reforms introduced by the crisis on social groups.