title: Linking Health System Responsiveness to Political Rights and Civil Liberties: A Multilevel Analysis Using Data From 44 Countries.
abstract: Responsiveness is a dimension of health system functioning and might be dependent upon contextual factors related to politics. Given this, we performed cross-national comparisons with the aim of investigating: 1) the associations of political factors with patients' reports of health system responsiveness and 2) the extent to which health input and output might explain these associations. World Health Survey data were analyzed for 44 countries (n = 103 541). Main outcomes included, respectively, 8 and 7 responsiveness domains for inpatient and outpatient care. Linear multilevel regressions were used to assess the associations of politics (namely, civil liberties and political rights), socioeconomic development, health system input, and health system output (measured by maternal mortality) with responsiveness domains, adjusted for demographic factors. Political rights showed positive associations with dignity (regression coefficient = 0.086 [standard error = 0.039]), quality (0.092 [0.049]), and support (0.113 [0.048]) for inpatient care and with dignity (0.075 [0.040]), confidentiality (0.089 [0.043]), and quality (0.124 [0.053]) for outpatient care. Positive associations were observed for civil liberties as well. Health system input and output reduced observed associations. Results tentatively suggest that strengthening political rights and, to a certain extent, civil liberties might improve health system responsiveness, in part through their effect on health system input and output.
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands margot.witvliet@svt.ntnu.no.
authors.forename: Margot I
authors.initials: MI
authors.lastname: Witvliet
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.affiliation: Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Mahapatra
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA UCLA Center for Health Policy Research, Los Angeles, California, USA.
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
mesh_terms: D002961:Civil Rights; D003142:Communication; D003219:Confidentiality; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D014943:Global Health; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D055361:Multilevel Analysis; D011057:Politics; D011787:Quality of Health Care; D012959:Socioeconomic Factors
keywords: global health; health system responsiveness; multilevel methods; politics; world health survey