When Democracy Shapes Health Outcomes
Public spending on health is often assumed to produce better outcomes, but the effectiveness of that investment can depend on the political systems that govern how resources are used. This research examines how democratic governance influences the relationship between health expenditure and public health outcomes across Europe.
This research was presented at the Graduate Poster Exhibition during the 2025 SPARK! (Showcase of Projects, Art, Research, and Knowledge). Developed within the Ph.D. program in Public Affairs | Community Development, the project was completed by Chengcheng (Zach) Yue. Using cross-national data from OECD European countries, the study explores how democratic institutions and governance quality shape the effectiveness of public health spending.
Abstract: The Impact of Health Expenditure and Democratic Quality on Health Outcomes: Evidence from OECD European Countries
The relationship between health expenditure and health outcomes is highly context dependent and shaped by political, social, and governance structures within democratic systems. While numerous studies have examined this relationship, research specifically focused on OECD European countries remains limited.
This study examines how the quality of democracy moderates the impact of health expenditure on health outcomes using a fixed effects model. A panel dataset covering 27 OECD European countries from 2000 to 2015 was constructed using data from multiple sources including the Economist Group, Global Welfare, the World Bank, the International Monetary Fund, the World Health Organization, and the Organisation for Economic Co-operation and Development.
Democracy quality is measured using the Democracy Index developed by the Economist Group. The index includes five key components: electoral process and pluralism, functioning of government, political participation, political culture, and civil liberties.
Health expenditure, the primary independent variable, is measured as domestic general government healthcare expenditure as a percentage of GDP. Health outcomes, the dependent variables, include life expectancy at birth, number of hospitals per million population, number of physicians per 1,000 population, pharmaceutical sales, and perceived health status.
By analyzing both the overall Democracy Index and its individual components, this study provides a nuanced understanding of how democratic quality moderates the relationship between health expenditure and health outcomes. The findings contribute to a deeper understanding of how governance structures influence the effectiveness of public health investment.
Graduate Poster Exhibition at SPARK!
The Graduate Poster Exhibition celebrates the research and creative work of the graduate community, showcasing everything from prose and code to original research and artistic expression. As part of SPARK! (Showcase of Projects, Art, Research, and Knowledge), a reimagining of Research Week, the exhibition highlights the depth, range, and impact of graduate scholarship and invites the campus community to engage with ideas taking shape across disciplines.
Transform Communities with Rutgers–Camden’s Public Affairs Graduate Programs
Rutgers University–Camden offers M.S. and Ph.D. programs in Public Affairs/Community Development, focusing on public policy, urban affairs, and political economy. The curriculum addresses community power, urban sustainability, and social justice, providing advanced research skills through courses like Statistical Inquiry and Geospatial Analysis. Students can engage in practical experiences via research centers such as the Senator Walter Rand Institute for Public Affairs and the Center for Urban Research and Education. The program offers flexible pathways, including a 30-credit M.S. degree suitable for part-time students, a 2+3 model combining M.S. and Ph.D. studies, and a 66-credit Ph.D. program. Notably, Rutgers–Camden’s Public Affairs program is recognized among the top public affairs schools by U.S. News & World Report.
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