Health services research in the era of new welfare state theories: Political, welfare state, and health care determinants of population health in wealthy countries

I investigate the political, welfare-state, and health system pathways through which macro-level political economic factors affect population health using macro-comparative analytical techniques. I study the health effects of the political power and ideologies that enabled the establishment of welfare and health care systems, as well as the relationship between health services and welfare state are studied. Main data sources include the Comparative Welfare State Dataset and the OECD Health Data 2000 and 2006 for the period of 1960 to 2000 (41 years) in 19 wealthy countries. Low birth weight and infant mortality rate are outcome variables.;Multilevel analyses testing whether welfare state regime type affects population health status revealed that Social Democracies as a group show significantly better population health status compared to other countries. Next, multivariate regressions, incorporating political power, welfare state, and health services indicators, were conducted to explain observed health status differences among welfare state regimes. While political and welfare state determinants are significantly associated with population health, the more proximal health care variables (i.e., public medical coverage) better predict population health status.;The interplay between welfare state and health services decommodification and universalism, and the effect of the US as a statistical outlier are investigated in last analyses. Bivariate regressions with a multiple imputed dataset revealed that the statistically significant correlation between the percentage of public medical coverage and health outcomes is largely due to the inclusion of the US, but that the explanatory power of political power, welfare state score and welfare state regime types remain stable.;As a conclusion, I propose a concept of "welfare-health care mix," which claims that population health status can only be predicted through an integral understanding of the unique mixture of the welfare state and health care arrangements of a country. To achieve a further improvement in population health status, health services research in the 21 st century should focus on wider contextual determinants of population health including welfare state and labor policy, at the same time defending or improving the current status of public health care services.