Health system efficiency and democracy: A public choice perspective.

Due to increasing demand and scarce financial resources for healthcare, health system efficiency has become a major topic in political and scientific debates. While previous studies investigating determinants of health system efficiency focused primarily on economic and social influence factors, the...

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Autores principales:	Martin Roessler, Jochen Schmitt
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/36d2c846b9d848b2996e65bb7d58b8dd
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spelling	oai:doaj.org-article:36d2c846b9d848b2996e65bb7d58b8dd2021-12-02T20:08:29ZHealth system efficiency and democracy: A public choice perspective.1932-620310.1371/journal.pone.0256737https://doaj.org/article/36d2c846b9d848b2996e65bb7d58b8dd2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256737https://doaj.org/toc/1932-6203Due to increasing demand and scarce financial resources for healthcare, health system efficiency has become a major topic in political and scientific debates. While previous studies investigating determinants of health system efficiency focused primarily on economic and social influence factors, the role of the political regime has been neglected. In addition, there is a lack of formal theoretical work on this specific topic, which ensures transparency and logical consistency of arguments and implications. Using a public choice approach, this paper provides a rigorous theoretical and empirical investigation of the relationships between health system efficiency and political institutions. We develop a simple principal-agent model describing the behavior of a government with respect to investments in population health under different political regimes. The main implication of the theoretical model is that governments under more democratic regimes put more effort in reducing embezzlement of health expenditure than non-democratic regimes. Accordingly, democratic countries are predicted to have more efficient health systems than non-democratic countries. We test this hypothesis based on a broad dataset including 158 countries over the period 1995-2015. The empirical results clearly support the implications of the theoretical model and withstand several robustness checks, including the use of alternative indicators for population health and democracy and estimations accounting for endogeneity. The empirical results also indicate that the effect of democracy on health system efficiency is more pronounced in countries with higher income levels. From a policy perspective, we discuss the implications of our findings in the context of health development assistance.Martin RoesslerJochen SchmittPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0256737 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Martin Roessler Jochen Schmitt Health system efficiency and democracy: A public choice perspective.
description	Due to increasing demand and scarce financial resources for healthcare, health system efficiency has become a major topic in political and scientific debates. While previous studies investigating determinants of health system efficiency focused primarily on economic and social influence factors, the role of the political regime has been neglected. In addition, there is a lack of formal theoretical work on this specific topic, which ensures transparency and logical consistency of arguments and implications. Using a public choice approach, this paper provides a rigorous theoretical and empirical investigation of the relationships between health system efficiency and political institutions. We develop a simple principal-agent model describing the behavior of a government with respect to investments in population health under different political regimes. The main implication of the theoretical model is that governments under more democratic regimes put more effort in reducing embezzlement of health expenditure than non-democratic regimes. Accordingly, democratic countries are predicted to have more efficient health systems than non-democratic countries. We test this hypothesis based on a broad dataset including 158 countries over the period 1995-2015. The empirical results clearly support the implications of the theoretical model and withstand several robustness checks, including the use of alternative indicators for population health and democracy and estimations accounting for endogeneity. The empirical results also indicate that the effect of democracy on health system efficiency is more pronounced in countries with higher income levels. From a policy perspective, we discuss the implications of our findings in the context of health development assistance.
format	article
author	Martin Roessler Jochen Schmitt
author_facet	Martin Roessler Jochen Schmitt
author_sort	Martin Roessler
title	Health system efficiency and democracy: A public choice perspective.
title_short	Health system efficiency and democracy: A public choice perspective.
title_full	Health system efficiency and democracy: A public choice perspective.
title_fullStr	Health system efficiency and democracy: A public choice perspective.
title_full_unstemmed	Health system efficiency and democracy: A public choice perspective.
title_sort	health system efficiency and democracy: a public choice perspective.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/36d2c846b9d848b2996e65bb7d58b8dd
work_keys_str_mv	AT martinroessler healthsystemefficiencyanddemocracyapublicchoiceperspective AT jochenschmitt healthsystemefficiencyanddemocracyapublicchoiceperspective
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Health system efficiency and democracy: A public choice perspective.

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