ABSTRACT
How has public healthcare spending prepared countries for tackling the COVID-19 pandemic? Arguably, spending is the primary policy tool of governments for providing effective health. We argue that the effectiveness of spending for reducing COVID deaths is conditional on the existence of healthcare equity and lower political corruption because the health sector is particularly susceptible to political spending. Our results, obtained using ordinary least squares and two-stage least squares estimations, suggest that higher spending targeted at reducing inequitable access to health has reduced COVID deaths. Consistent with the findings of others, our results indirectly suggest that health spending is necessary, but not sufficient unless accompanied by good governance and equitable access. Equitable health systems ease the effects of COVID presumably because they allow states to reach and treat people more effectively. Spending aimed at increasing health system capacity by increasing access thus seems a sound strategy for fighting the spread of disease, ultimately benefiting us all.
ABSTRACT
How has public healthcare spending prepared countries for tackling the COVID-19 pandemic? Arguably, spending is the primary policy tool of governments for providing effective health. We argue that the effectiveness of spending for reducing COVID deaths is conditional on the existence of healthcare equity and lower political corruption because the health sector is particularly susceptible to political spending. Our results, obtained using ordinary least squares and two-stage least squares estimations, suggest that higher spending targeted at reducing inequitable access to health has reduced COVID deaths. Consistent with the findings of others, our results indirectly suggest that health spending is necessary, but not sufficient unless accompanied by good governance and equitable access. Equitable health systems ease the effects of COVID presumably because they allow states to reach and treat people more effectively. Spending aimed at increasing health system capacity by increasing access thus seems a sound strategy for fighting the spread of disease, ultimately benefiting us all.
ABSTRACT
AIMS: The COVID-19 pandemic has led to a spate of studies showing a close connection between inequitable access to health care, welfare services and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question by asking whether more 'egalitarian' forms of democracy matter, given that they contain more equitable health-care access and societal infrastructure, such as social capital and trust. METHODS: We use standard regression techniques, including instrumental variables analysis addressing endogeneity on COVID-19 testing and deaths data as of the end of May and beginning of September. We use novel data from the Varieties of Democracy Project on health-system equity and egalitarian democracy. RESULTS: Our results suggest that more equitable access to health care increases testing rates and lowers the death rate from COVID-19. Broader egalitarian governance, measured as egalitarian democracy, however, shows the opposite effect. Thus, factors associated with health-care capacity to reach and treat matter more than broader societal factors associated with social capital and trust. The results are robust to alternative testing procedures, including instrumental variable technique for addressing potential endogeneity. CONCLUSIONS: Despite a great deal of public health focus on how equitable governance helps fight the adverse effects of so-called neoliberal pandemics, we find that broadly egalitarian factors have had the opposite effect on fighting COVID-19, especially when an equitable health system has been taken into account. Fighting disease, thus, might be more about the capacity of health systems rather than societal factors, such as trust in government and social capital.