Welfare state matters: a typological multilevel analysis of wealthy countries

Building on the social science literature, we hypothesized that population health indicators in wealthy industrialized countries are 'clustered' around welfare state regime types. We tested this hypothesis during a period of welfare state expansion from 1960 to 1994. We categorized data from 19 wealthy countries into 4 different types of welfare state regimes (Social Democratic, Christian Democratic, Liberal and Wage Earner Welfare States). Outcome variables were the infant mortality rate (IMR) and the low birth weight rate (LBW), obtained from the Organization of Economic Co-operation and Development (OECD) Health Data 2000 and from the United Nations Common Statistical Database (UNCSD). A two-level multilevel model was constructed, and fixed effects of welfare state were tested. Through the 39 years analyzed, Social Democratic countries exhibited a significantly better population health status, i.e., lower infant mortality rate and low birth weight rate, compared to other countries. Twenty percent of the difference in infant mortality rate among countries could be explained by the type of welfare state, and about 10% for low birth weight rate. The gap between Social Democracies and other countries widened over the 1990s. Our results confirm that countries exhibit distinctive levels of population health by welfare regime types even when adjusted by the level of economic development (GDP per capita) and intra-country correlations. It implies that countries, as groups, adopt similar policies or through any other ways, achieve similar level of health status. Proposed mechanisms of such process and suggestions for future research directions are presented in the discussion.