Do multiparty elections improve human development in autocracies?

Kim, Nam Kyu; Kroeger, Alex

doi:10.1080/13510347.2017.1349108

Cited by 13 publications

(19 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…36 37 38 39 40 41 Some studies have examined the impact of autocratic regime types on health outcomes. 42 43 Others have examined the effect of transitions from autocracy to democracy on health outcomes. 6 23 44 However, few have assessed the effects of democratic erosion (ie, autocratisation) on health outcomes and none have considered its effects on UHC.…”

Section: Discussionmentioning

confidence: 99%

“…Previous cross country studies on the political determinants of health have focused on the impact of the overall degree of democracy on healthcare spending, health service inputs, and population health outcomes 363738394041. Some studies have examined the impact of autocratic regime types on health outcomes 4243. Others have examined the effect of transitions from autocracy to democracy on health outcomes 62344.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Autocratisation and universal health coverage: synthetic control study

Wigley

Dieleman

Templin

et al. 2020

BMJ

View full text Add to dashboard Cite

Objective To assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress toward universal health coverage (UHC). Design Synthetic control analysis. Setting and country selection Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. Main outcome measures HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. Results Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. Conclusions Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Autocratisation and universal health coverage: synthetic control study

Wigley

Dieleman

Templin

et al. 2020

BMJ

View full text Add to dashboard Cite

show abstract

“…A few recent studies have considered the combined effect of state capacity and democracy. One approach is a mediation analysis arguing that democracy affects state capacity, which then affects human development (Kim and Kroeger, 2018). Another is simply to control for state capacity when investigating the effect of democracy.…”

Section: Democracy and State Capacity As Mutually Reinforcing: Incentmentioning

confidence: 99%

Motivated and Able to Make a Difference? The Reinforcing Effects of Democracy and State Capacity on Human Development

Grundholm

Thorsen

2019

St Comp Int Dev

View full text Add to dashboard Cite

This paper investigates to what extent and under what conditions democracy and state capacity affect human development. We argue that democratic institutions provide leaders with incentives for improving human development, whereas capable state apparatuses enable them to do so. Accordingly, we argue that the two factors reinforce the effects of each other and that the highest levels of human development are achieved when high levels of both factors are present. Our argument contradicts earlier studies, which have claimed that the effects of the two factors crowd out one another. We investigate the proposition through time-series cross-sectional analyses, employing new and improved measures of both democracy and state capacity. These new measures not only give our analysis an advantage in terms of measurement validity; they also substantially increase its temporal scope compared to previous studies. Consequently, we analyze a global sample of countries spanning the period 1902-2008. The results provide strong support for our theoretical expectations, and they are robust to both alternative measures and different model specifications. Our results highlight the importance of building capable state structures and democracy in conjunction and have significant implications for scholars and practitioners of development policy.

show abstract

“…In addition, previous studies on electoral institutions and health issues in EAs can be summarized as follows: first, previous studies assign actual health outcomes and policies such as child mortality rates (Kim and Kroeger, 2018;Miller, 2015), secondary school enrolment (Cassani, 2017), calories consumption (Bellinger, 2020), and social assistance programs (Fails, 2020). Outcomes such as mortality rates are measures to capture popular well-being, whereas the expenditure measures government effort (Geddes et al, 2018: 148).…”

Section: Introductionmentioning

confidence: 99%

Does intense electoral competition increase the government health expenditure in EAs?

Lee¹

2021

Preprint

View full text Add to dashboard Cite

Does intense electoral competition in electoral autocracies (EAs) increase the government health expenditure? Previous studies on EAs and public health expenditure focus on the presence of multiparty elections in EAs as a significant determinant on the expenditure. Most of elections in EAs often are unfair because those are for the victory of dictators; hence. multiparty elections per se do not capture well-known impact of elections, such as the electoral competition increasing health expenditure. Some EAs pay health expenditure less than others even though electoral competition is high. This paper analyzes the effect of electoral competition on the government health expenditure with the balanced panel data of 20 EAs from 2001 to 2017. There are two rival arguments on how electoral competition affect the expenditure according to previous studies; (a) a high level of electoral competition indicates a difficulty of dictatorial winning in elections. Autocrats, hence, gather various demands including health issues from voters, and can increase the government health expenditure; (b) Autocrats pursue the victory in elections. Pork and personal benefits to voters rather than programmed policies are helpful for the victory. Therefore, there is no incentive for autocrats to provide government health expenditure to voters when the level of electoral competition is high. Empirical findings demonstrate that electoral competition in EAs lead the decrease of government health expenditure. This paper concludes that electoral competition does not increase the public health expenditure; the higher level of competition in autocracies does not mean that voters can exert their power to autocrats to realize policies.

show abstract

Do multiparty elections improve human development in autocracies?

Cited by 13 publications

References 33 publications

Autocratisation and universal health coverage: synthetic control study

Autocratisation and universal health coverage: synthetic control study

Motivated and Able to Make a Difference? The Reinforcing Effects of Democracy and State Capacity on Human Development

Does intense electoral competition increase the government health expenditure in EAs?

Contact Info

Product

Resources

About