Democracies more likely than autocracies to maintain universal health coverage

Despite widespread recognition that universal health coverage is a political choice, the roles that a country's political system plays in ensuring essential health services and minimizing financial risk remain poorly understood.

To assess the relationships that democratic quality has with universal health coverage and government health financing, Tara Templin of Stanford University and coauthors examine both private and government observational data and indices from 170 countries from 1990 to 2019. Of those countries, 73 were classified as democratic and the remainder autocratic. The authors found that for the democratic countries, per person government health spending increased from $326 to $601 during the study period; in contrast, in autocratic countries the per person spending grew less dramatically, going from $77 to $192.

According to the authors, democracies are also more likely than autocracies to maintain universal health coverage, even amid economic recessions, which may have significance for the economic turndown spurred by the COVID-19 pandemic. During these times, the authors note, global institutions and development assistance providers may need to adjust their policy recommendations and activities to achieve the best possible results in countries where political leaders lack sufficient electoral incentives to provide high-quality health care to the citizenry.