Abstract：
BACKGROUND:A country's health expenditure significantly improves its population health status. This study aims to examine the determinants of health expenditure in dictatorships. METHODS:We designed a mixed methods research approach. First, we used panel data from 1995 to 2014 covering 99 countries (n = 1488). Fixed effects regression models were fitted to determine how different types of authoritarianism relate to health expenditure. Second, we chose Ivory Coast to apply the synthetic control methods for a case study. We constructed a synthetic Ivory Coast, combining other dominant party regimes to resemble the values of health expenditure predictors for Ivory Coast prior to a regime change from a dominant party system to personalist dictatorships in 2000. RESULTS:We found that dominant party autocracies, compared with non-dominant party regimes, increased health expenditure (% of GDP) (1.36 percentage point increase, CI = 0.59-2.12). The marginal effect, however, decreased when an autocrat in this type of regime held elections (0.86 percentage point decrease, CI = 0.20-1.52). Furthermore, we found the difference in health expenditure between the actual Ivory Coast and its synthetic version starts to grow following the regime change in 2000 (in 2000, actual: 6.00%, synthetic: 6.04%; in 2001, actual: 4.85%, synthetic: 5.99%), suggesting a pronounced negative effect of the government transition on Ivory Coast health expenditure. CONCLUSION:The findings suggest that different forms of dictatorship are associated with varying levels of health expenditure. Where dictatorships rely on popular support, as is the case with dominant party dictatorships, health expenditure is generally greater.
journal_name
Eur J Public Healthjournal_title
European journal of public healthauthors
Yan HT,Lin YCdoi
10.1093/eurpub/ckz070subject
Has Abstractpub_date
2019-12-01 00:00:00pages
1172-1177issue
6eissn
1101-1262issn
1464-360Xpii
5477840journal_volume
29pub_type
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