How time horizons of autocrats impact health expenditure: a mixed methods research

Abstract

Background: A country's spending on healthcare significantly improves its population health status. No comparative study has examined how the threat perceived by leaders influences health expenditure and cross-national analyses of authoritarian regimes. The objectives of this study are to examine how time horizons of autocrats influence health expenditure. Methods: We designed a mixed methods research approach. First, the study used panel data from 1995 to 2010 covering 95 countries (n = 1208) and applied fixed effects regression models. As a proxy for time horizons, the study generated the predicted survival time for each regime-year using parametric survival analysis and the predictors to model regime failure. Second, we chose Chad, Rwanda and Ivory Coast to apply synthetic control methods for comparative case studies. Armed conflict had significant effects on regime duration and was used for an intervention. We constructed a synthetic version of each country, combining counties that did not or did experience armed conflict to resemble the values of health expenditure predictors for the actual country prior to the intervention. Results: We found that an increase in the natural log form of survival time by 1 resulted in a 1.14 percentage point increase in health expenditure (% of GDP) (1.14, 95% CI = 0.60-1.69). Furthermore, we found that the difference in health expenditure between the actual Chad and its synthetic version starts to grow following the civil war in 2004 (in 2004, actual: 5.72%, synthetic: 5.91%; in 2005, actual: 3.91%, synthetic: 6.74%). Similarly, a large health expenditure gap between the actual Rwanda and its synthetic control resulted after the peace deal was signed in

Determinants of public health spending in WAEMU area: An empirical investigation

“…They promote a more flexible adjustment of resources to changes in internal and external conditions, and thereby generate faster growth. In addition, a recent study conducted by Yan-Lin (2020) on Côte d'Ivoire, Rwanda and Chad concerning the evolution of health spending over time (in a situation of conflict, and political stability), reveals that in times of armed conflict, health expenditure is down compared to the norm respectively for the study countries: Côte d'Ivoire, 6.522% (ref 7.109%) in 1998 and 6.521% (ref 6.682%) in 2010. Rwanda, 4.573% (ref 4.804%) in 2002 and 6.342% (ref 5.028%) in 2005.…”

Electoral competition and government health expenditure in electoral autocracies: A pessimistic view

“…Yan and Lin (2019, 2020) suggest that two variables affect health expenditures in autocracies: a hegemonic party regime and a long duration for autocratic survival. They argue that the legitimacy of the dominant party's rule is based on the regime's popularity rather than on its support for specific groups; hence, autocrats in dominant party regimes must pay close attention to the health of the population and increase health expenditures accordingly (Yan and Lin, 2019: 1172).…”

“…They argue that the legitimacy of the dominant party's rule is based on the regime's popularity rather than on its support for specific groups; hence, autocrats in dominant party regimes must pay close attention to the health of the population and increase health expenditures accordingly (Yan and Lin, 2019: 1172). Furthermore, Yan and Lin argue that a short time horizon motivates dictators to exploit citizens for their personal benefit, while regimes that hope to endure must provide public goods (Yan and Lin, 2020). Such studies do not address how electoral institutions in autocracies affect health expenditures.…”