Healthcare funding and its relationship to equity and outcomes: A QCA analysis of Commonwealth Fund and OECD data

Abstract

This article examines Organisation for Economic Co-operation and Development (OECD) and Commonwealth Funding data to explore the relationship between the level and means of funding of 11 different healthcare systems, on the one hand, and overall equity and health outcome measures, on the other. It utilises qualitative comparative analysis (QCA) and the idea of ‘fitness landscapes’ for the clusters of funding combinations and outcomes they present. It finds that health systems with relatively high levels of voluntary health insurance tend to be associated with poor outcomes almost across the board, but healthcare systems with higher overall expenditures combined with low voluntary insurance levels offer combinatory possibilities for achieving both high equity and high outcomes. The article also explores how ‘contradictory cases’ can be used to explore how systems falling short of the outcomes of others with the same funding patterns, might find improvements.