1 / 23

Welfare State Matters: A Typological Multilevel Analysis of Wealthy Countries

Welfare State Matters: A Typological Multilevel Analysis of Wealthy Countries. Hae-Joo Chung, RPh, MSc Department of Health Policy and Management, The Johns Hopkins School of Public Health. Summary of Today’s Presentation.

donoma
Download Presentation

Welfare State Matters: A Typological Multilevel Analysis of Wealthy Countries

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Welfare State Matters: A Typological Multilevel Analysis of Wealthy Countries Hae-Joo Chung, RPh, MSc Department of Health Policy and Management, The Johns Hopkins School of Public Health

  2. Summary of Today’s Presentation • To assess the relevance of ‘welfare-state typologies’ to public health research, • And to extend the social epidemiology based on the ‘income inequality paradigm’ • We analyzed 3 level conditional hierarchical models of the population health data from 19 wealthy countries of the last 35 years • As a result, the regime-type effects, especially social democratic regime type had a strong explanatory power • And we could see that the social democracies had maintained better population health status for the last 35 years

  3. Welfare State Typologies • Welfare-state typology has been proved to be a useful explanatory device for the emergence of welfare states, including national health policies • Three (Esping-Andersen) or four (Huber & Stephens) regime-type clusters based on qualitatively different arrangements between state, market and family • “Liberal” Welfare States • “Wage Earner” Welfare States • “Conservative-Corporatist” Welfare States • “Social Democratic” Welfare States Huber E and Stephens JD (2001) Development and Crisis of the Welfare State Esping-Andersen G. (1990) The Three Worlds of Welfare Capitalism More generous

  4. The Field of Political · Welfare State Determinants of Health • The “Relative Income Hypothesis” and “Political and Welfare-state determinants of Health”, two possible mechanisms • Welfare state variables are used to determine the structural mechanism through which economic inequality affects population health status • Studies suggest that welfare state variables (e.g., access to health care) could be important predictors of population health outcomes • However, only one study included a comprehensive number of political variables that adjust for economic determinants Coburn, 2000; Conley & Springer, 2001; Navarro & Shi, 2001; Macinko, Starfield, & Shi, 2003; Macinko, Shi, & Starfield, 2004; Muntaner, Lynch, Hillemeier, Lee, David, Benach et al., 2002

  5. Methodological Individualism in Comparative Health Policy Analyses • Assumes covariances • Among the observations within each country • Not between/ among countries • Outcomes of a country are explained by explanatory variables of that country • Countries are independent from each other Country-level fixed-effects models using panel datasets Country A Year Obs 1990 a 1991 b 1992 c . . . Country B Year Obs 1990 a´ 1991 b´ 1992 c´ . . . These are dependent These are independent

  6. Aim • To develop a more realistic model for comparative health policy analyses than widely used country-level fixed effects model • To examine the change in selected population health indicators in advanced capitalist countries in the last 35 years (1965-1994), especially before and after the neo-liberal welfare reform

  7. Hypothesis Better Health Social Democracies Christian Democracies Wage Earner Liberal Worse Health Generosity of the Welfare-state System Generosity of the Welfare-state System [ A “Linear” Distribution ] [ A Distribution as “Clusters” ]

  8. 19 wealthy countries, 1960 - 1994 (35 years) Social Democratic Denmark Finland Norway Sweden Christian Democratic Austria Belgium France Italy Luxembourg* Netherlands Switzerland (West) Germany Wage Earner Australia Japan* New Zealand Liberal Canada Ireland The United Kingdom The United States of America Countries and Categorizations

  9. Outcome Variables and Data Sources • Outcome variables • The infant mortality rate (IMR) • The Low birth weight rate (LBW) • Data source • The OECD Health Data 2000

  10. Three-level Conditional Hierarchical Mixed-effects Models: A Diagram • Level k: Welfare state regimes • k1=0, 1, 2, 3, or • k2=0, 1 • Fixed effects • Level j: Countries • j=1, 2, 3, …, 19 • Random effects • Level i: Years • i=0, 1, 2, …, 34 • Random effects k2=0 k2=1 k1=0 k1=1 k1=2 k1=3 … … …

  11. Statistical Analyses 1 2 • Two outcomes (IMR and LBW) were analyzed separately • SAS version 8.2 was used to obtain the estimates through the REML method 3

  12. Values for Fixed Intercepts for IMR and LBW in the 4 Regime Types All intercepts p<0.001

  13. Results from the Analysis with 4 Welfare State Regime Types

  14. Results from the Analysis with 2 Welfare State Groups, 1960-1994 • Variance components for ‘year’ and ‘country’-level random-effects are highly significant • All fixed-effects intercepts for ‘welfare state regime types’ are highly significant • F-test is significant for both outcomes

  15. Change in Excess Infant Mortality Rate and Excess Low Birth Weight Rate:Social Democracies vs Others LBW (μ0 -μ1) μ0 IMR

  16. Variance Components LBW IMR

  17. Summary • Our results provide a more appropriate account of country and regime effects than the usual pooled regression analysis used in comparative health policy analysis. • Our results confirm that countries as clusters or groups share certain characteristics pertaining to them, as opposed to countries as individuals • The Social Democratic regime was significantly different from other countries as a whole • During the era of welfare state retrenchment, the difference in the low birth weight rate between social democracies and other countries was magnified

  18. These Findings Could Be Due to, • The development of domestic welfare state social policies • universal access to health care • higher female employment in the labor market • higher unemployment compensation • subsidies to single mothers and divorced women • active labour-market intervention to ensure full employment, especially among women • Or any supra-national structure: EU, NAFTA, etc. • Or the geographical proximity (policy diffusion)

  19. Implications of the Different Pattern between IMR and LBW • The Social Democratic countries managed to maintain a healthier social environment, including smaller economic inequality, even after 1979, the era of welfare state retrenchment • This finding is also consistent with Huber & Stephens’ (2001) finding: in the changed environment of the 1980s, “the active, service-oriented Social Democratic welfare states were in a stronger position than the passive, transfer-oriented Christian Democratic welfare states” (p.321) • This statement also applies to the Liberal and Wage Earner welfare states that had started “ideologically driven cuts” (p.320) in the state welfare funding much earlier in time

  20. This study shows that population-level health indicators, such as infant mortality rate and low birth weight, have components of variance at the welfare state type supranational level (15% to 50% or more of the total variability) This study combined a longitudinal approach with a multi-level modeling approach to get stronger inferences We do not know for sure if the observed distinctive characteristics in population health are because of policy/ political differences or just reflections of geographical difference. (i.e., All Social Democratic Countries are located in Nothern Europe, whereas all Liberal countries are outside Europe, except the UK, which is a island) We do not know what aspect of welfare state regimes resulted in the difference in population health levels Contributions and Limitations CONTRIBUTIONS LIMITATIONS

  21. Welfare state policies affecting maternal and child health indicators begin at a supranational level Comparative health policy studies should not consider countries as being independent from one anther The differences in population health indicators among these countries distribute as distinctive clusters of welfare state regime types More protective types of welfare state regimes, namely Social Democratic countries as a group, were able to provide a more population health-friendly environment to its citizens in the last 35 years Future studies should investigate the specific welfare regime features (i.e., by using explanatory variables) that account for welfare regime effects on maternal and child health and other related population health indicators Conclusion and Future Directions CONCLUSION FUTURE DIRECTIONS

  22. References • Abbott, A., & DeViney, S. (1992). The welfare state as transnational event: evidence from sequences of policy adoption. Social Science History, 16(2), 245-274. • Alesina, A., & Glaeser, E. (2004). Fighting Poverty in the Us and Europe: A World of Difference Oxford: Oxford University Press • Breen, R., & Rottman, D.B. (1998). Is the national state the appropriate geographical unit for class analysis? Sociology, 32(1), 1-21. • Castles, F., & Mitchell, D. (1993). Worlds of welfare and families of nations. In F.G. Castels (Ed.), Families of Nations: Public Policy in Western Democracies (pp. 93-129). Brookfield, VT: Dartmouth. • Cho, Y. (2001). Confusionism, conservatism, or liberalism? A study on the typology of Korean Welfare State. Korean Journal of Sociology, 35(6), 169-191. • Coburn, D. (2000). Income inequality, social cohesion and the health status of populations: The role of neo-liberalism. Social Science and Medicine, 51(1), 135-146. • Conley, D., & Springer, K. (2001). Welfare state and infant mortality, American Journal of Sociology pp. 768-807). • Esping-Andersen, G. (1990). The Three Worlds of Welfare Capitalism Princeton: Princeton University Press • Esping-Andersen, G. (1999). Social Foundations of Postindustrial Economies Oxford: Oxford University Press • Goodman, R., & Peng, I. (1996). The East Asian Welfare States: Peripatetic Learning, Adaptive Change and Nation-Building. In G. Esping-Andersen (Ed.), Welfare States in Transition.London: SAGE. • Hong, K. (1991). A Qualitative comparative study on the welfare state typology: Interventionist, Liberal, and Confucian Welfare State, A Study of Korean Welfare System (pp. 119-151). Seoul: Na-Nam. • Huber, E., & Stephens, J. (2001). Development and Crisis of the Welfare State- Parties and Policies in Global Markets Chicago: University of Chicago Press • Jones, C. (1993). The pacific challenge: Confucian Welfare States. In C. Jones (Ed.), New Perspectives on the Welfare State in Europe.London: Routledge. • Korpi, W., & Palme, J. (2003). Class politics and "new polibcs" in the context of austerity and globalization: Welfare state regress in 18 countries 1976-1995. Sociologisk Gorskning, 4, 45-85.

  23. References (Cont’d) • Littlell, R., Smith, G., & Harper, S. (1996). SAS System for Mixed Models Cary, NC: SAS Institute Inc. • Lynch, J., Smith, G., Harper, S., Hillemeier, M., Ross, N., Kaplan, G., & Wolfson, M. (2004). Is income inequality a determinant of population health? Part 1. A systematic review. Milbank Quarterly, 82(1), 5-99. • Macinko, J., Starfield, B., & Shi, L.Y. (2003). The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Services Research, 38(3), 831-865. • Macinko, J.A., Shi, L.Y., & Starfield, B. (2004). Wage inequality, the health system, and infant mortality in wealthy industrialized countries, 1970-1996. Social Science & Medicine, 58(2), 279-292. • Muntaner, C., Lynch, J., Hillemeier, M., Lee, J., David, R., Benach, J., & Borrell, C. (2002). Economic inequality, working-class power, social capital and cause-specific mortality in wealthy countries. International Journal of Health Services, 32(4), 629-656. • Navarro, V., & Shi, L. (2001). The political context of social inequalities and health. Social Science and Medicine, 52(3), 481-491. • Navarro, V., Borrell, C., Benach, J., Muntaner, C., Quiroga, A., Rodriguez-Sanz, M., Verges, N., Guma, J., & Pasarin, M. (2004). The importance of the political and the social in explaining mortality differentials among the countries of the OECD, 1950-1998. International Journal of Health Services, 33(3), 419-494. • Preston, S.H. (1975). The changing relation between mortality and level of economic development. Population Studies, 29(2), 231-248. • Rodgers, G. (1979). Income and inequality as determinants of mortality: An international cross-section analysis. Population Studies, 33(3), 343-351. • Shi, L., Macinko, J., Starfield, B., Wulu, J., Regan, J., & Politzer, R. (2003). The relationship between primary care, income inequality, and mortality in US states, 1980-1995. The Journal of the American Board of Family Practice, 16, 412-422. • Wagstaff, A., & van Doorslaer, E. (2000). Income inequality and health: What does the literature tell us? Annual Review of Public Health, 21, 543-567. • Wilkinson, R. (1996). Unhealthy Societies: The Afflictions of Inequality New York: Routledge

More Related