Article Text


Epidemiology and policy
P1-371 What's politics got to do with global healthcare? A multilevel examination of individual-patient reports of health system responsiveness in 45 low, middle and high income
  1. M Witvliet1,
  2. A Kunst1,
  3. K Stronks1,
  4. T Mahapatra2,
  5. C A Thompson2,
  6. O A Arah1,2
  1. 1Academic Medical Center (AMC), University of Amsterdam, Department of Public Health, Amsterdam, The Netherlands
  2. 2UCLA School of Public Health, Los Angeles, California, USA


Introduction Patient responsiveness, often measured as patient experiences of healthcare, is a core dimension of health system functioning. Seldom is this investigated globally, with little known about the influence of politics on how different national systems are responsive to their patients. Therefore, we investigate (1) the associations between patient responsiveness and political factors, and (2) the extent to which health system inputs and outputs might further explain associations.

Methods World Health Survey data were analysed in 45 countries (n=195 891). Main outcomes included eight responsiveness indicators for both in-and out-patient experiences. Multilevel linear regression was used to assess associations of individual patients' responsiveness with policy metrics (ie, civil liberties, political rights), general development (ie, per capita GDP and female literacy), health system inputs (ie, health spending and human resource capital), and health system outputs, measured by maternal mortality. We also adjusted for individual-level socioeconomic factors.

Results Political factors are associated with patient responsiveness. Measured on a 0–5 scale, political rights are more positively related to patient responsiveness than civil liberties. For example, betas and SE show that an increase in political rights indicates a 0.05 (SE 0.04) increase in attention, and a 0.02 (SE 0.05) increase in autonomy and choice, respectively. Associations with political factors are not greatly modified by general development indicators, nor by health system input or output.

Conclusion The manner in which a country is organised politically influences patient responsiveness. Strengthening a country's political infrastructure, might improve patient responsiveness, which may enhance health system functioning.

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