Democracy Dynamics in Health Expenditure and Outcomes in OECD European Countries

• In Event: Poster Session: Science, Technology, and Environmental Policy 1 & Comparative Health Policy
  In Poster Session: Poster Session: Comparative Health Policy

Abstract

The impact of health expenditure on health outcomes is intricately tied to the contextual nuances of political, social, and governance factors within democratic systems. Despite existing studies on this subject, a noticeable gap persists in the exploration of this relationship specific to OECD European countries. The political principles of democracy contribute to the prioritization of healthcare in budgetary allocations, with a focus on meeting the diverse healthcare needs of the population. The democracy characteristics within the OECD European countries can be varied, which would shape the distinct health expenditure and health outcomes. The significance of this study lies in its focus on OECD European countries, providing valuable insights into the role of democracy in shaping health spending and health outcomes across diverse democratic contexts. To address this gap, our study employs a robust fixed effects model to scrutinize how the quality of democracy moderates the association between health expenditure and health outcomes. Furthermore, our research aims to address the gap by posing the fundamental question: to what extent does the quality of democracy, measured by the democracy index and its individual components, moderate the relationship between health expenditure and various health outcomes in OECD European countries from 2000 to 2022? Utilizing a panel dataset covering all the OECD European countries from 2000 to 2022, we merge data from the Economist Group, Global Welfare, World Bank, International Monetary Fund, World Health Organization, and the OECD official website. Democracy quality is evaluated using the Economist Group's democracy index, encompassing elements such as electoral process and pluralism, functioning of government, political participation, political culture, and civil liberties. The dependent variable, health expenditure, is measured by domestic general government healthcare expenditure as a percentage of GDP. The independent variables for health outcomes include life expectancy at birth, number of hospitals per million population, number of physicians per 1000 population, pharmaceutical sales, perceived health status, and so on. Our study seeks to comprehensively explore the moderating roles of both the general democracy index and its individual components in shaping the intricate relationship between health expenditure and diverse health outcomes. Our results could observe variations in the moderating roles of individual components of the democracy index. Certain components may exhibit stronger or weaker moderating effects on the health expenditure and health outcomes relationship. Our study may uncover specific health outcomes that are more sensitive to changes in health expenditure within the context of varying democracy qualities.

Authors

• Chengcheng Yue, Rutgers University-Camden

• Lili Shang, University of New South Wales

• Yanan Li

• Wei Chen, Rutgers University-Camden