Health-system equity, egalitarian democracy and COVID-19 outcomes: An empirical analysis

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.

Pandemics Initially Spread Among People of Higher (Not Lower) Social Status: Evidence From COVID-19 and the Spanish Flu

“…In all nations, higher income regions (blue lines) initially show a steeper increase in COVID-19 cases than lower income regions (red lines). and England, Germany has a more egalitarian societal and medical system (Thelen, 2012), which should generally reduce the vulnerability of lower income people (Vadlamannati et al, 2021). Second, compared to the United States and England, Germany was rather successful at containing the pandemic (see Figure 1).…”

Do Bigger Health Budgets Cushion Pandemics? An Empirical Test of COVID-19 Deaths Across the World

“…Evidence suggests that countries that have more equal access to healthcare have been more successful in containing the virus and have experienced fewer deaths (Vadlamannati et al 2020a). For example, in Taiwan all citizens, and foreigners who are resident in Taiwan for at least six months, are entitled to a government insurance plan.…”

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