Belief Structures, Common Policy Space and Health Care Reform: A Q Methodology Study

Abstract

Debate on the merits of health care reform continues even after passage of the Affordable Care Act of 2010. Poll results confirm a split along political party and associated ideological lines with democrats more supportive and republicans generally opposed to the law. As parts of the law are now subject to increasing scrutiny, it may be instructive to question whether a party-centered or surrogate liberal/conservative dichotomy is the best representation of positions in the health care debate. Q Methodology reveals a more complex set of belief structures, suggesting that a simple dichotomy is misleading in terms of the values that underlie the role of health care in society. Five distinct belief structures were found, each with different concerns as to the purpose and potential benefits of various health care initiatives. In addition, Q Methodology allows for the formation of a common policy space within which all belief structures are independently in agreement in four specific areas. It is argued that this empirically derived consensus can serve as a basis for effective political engagement and policy implementation.