Healthcare funding and its relationship to equity and outcomes : a qualitative comparative analysis of commonwealth fund and OECD data

Greener, Ian (2019) Healthcare funding and its relationship to equity and outcomes : a qualitative comparative analysis of commonwealth fund and OECD data. Journal of European Social Policy. ISSN 0958-9287 (In Press)

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    Abstract

    This paper examines OECD data to explore the relationship between the level and means of funding of 11 different healthcare systems on the one hand, and Commonwealth Fund data which assess overall system performance, equity and health outcome measures on the other. It utilises Qualitative Comparative Analysis (QCA), and the idea of ‘fitness landscapes’ to analyse combinations of funding combinations and outcomes. It finds that health systems with relatively high levels of voluntary health insurance tend to be in sets of countries with low outcome measures, but that high outcome achievement is often part of fitness landscapes that are dependent upon specific combinations of funding patterns that make generalisations more difficult. The paper finds that medium levels of out-of-pocket expenditures, in combinations with other specific funding factors, and in opposition to existing work, are not incompatible with both high equity and high health outcomes scores. Finally, it explores how ‘contradictory cases’ can be used to explore how systems falling short of the outcomes of others with the same funding patterns might find improvements.