News Release

From Health Affairs: Democracies provide stronger universal health coverage than autocracies

Peer-Reviewed Publication

Health Affairs

Despite widespread recognition that universal health coverage is a political choice, the roles that a country’s political system plays in ensuring essential health services and minimizing financial risk remain poorly understood. To assess the relationships that democratic quality has with universal health coverage and government health financing, Tara Templin of Stanford University and coauthors examine both private and government observational data and indices from 170 countries from 1990 to 2019. Of those countries, 73 were classified as democratic and the remainder autocratic. The authors found that for the democratic countries, per person government health spending increased from $326 to $601 during the study period; in contrast, in autocratic countries the per person spending grew less dramatically, going from $77 to $192. According to the authors, democracies are also more likely than autocracies to maintain universal health coverage, even amid economic recessions, which may have significance for the economic turndown spurred by the COVID-19 pandemic. During these times, the authors note, global institutions and development assistance providers may need to adjust their policy recommendations and activities to achieve the best possible results in countries where political leaders lack sufficient electoral incentives to provide high-quality health care to the citizenry.

Also in the issue:

  • Trust In Governments And Health Workers Low Globally, Influencing Attitudes Toward Health Information, Vaccines; Corrina Moucheraud and coauthors from the University of California Los Angeles
  • Competition From Biosimilars Drives Price Reductions For Biologics In The French Single-Payer Health System; James C. Robinson of the University of California Berkeley and Quentin Jarrion of the University Hospitals of Reims (France)
  • Pandemic Fatigue: The Effects Of The COVID-19 Crisis On Public Trust And Compliance With Regulations In Israel; Moran Bodas and Kobi Peleg of the Gertner Institution (Israel)


Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through, Health Affairs Today, and Health Affairs Sunday Update.

Stay Up To Date With Health Affairs’ COVID-19 Resource Center: We’ve gathered blogs and journal articles, along with relevant content from our journal archive: lessons from previous pandemics, including school closures during the Spanish flu; public health preparedness; and communicating risk.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981. 

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