Democracy and access to health services
Walker, Mary Ellen
The relationship between political environment and health service accessibility (HSA) has not been the focus of any specific studies. The purpose of this ecological study is to address this gap in the literature related to the relationship between political environment and HSA. This relationship will be analyzed with the Kruskal-Wallis test, the Mann-Whitney test, and multiple least-squares regression using political environment measure, level of democracy as defined by the 2011 Economist Intelligence Unit Democracy Index (EIUDI) regime categorization, and HSA indicators (physicians, nurses, and hospital beds per 10,000 people). The level of democracy for each country on the EIUDI is classified by regime type (full democracy, flawed democracy, hybrid regime, and authoritarian regime), using the EIUDI sub-scores that the Economist Intelligence Unit (2011) considers to be the components of democracy (electoral processes and pluralism, functioning of government, political participation, political culture, and civil liberties). Multiple least-squares regression was used to determine the significant relationships among the EIUDI sub-scores and the HSA indicators. Kruskal-Wallis and Mann-Whitney tests detected significant differences in physicians, nurses, and hospital beds densities between different regime types. The Kuskal-Wallis test showed that there were differences in the distributions of physician densities between regime types (χ2 [3, N = 162] = 37.48, p = < .001), in the distributions of nurse densities between regime type (χ2 [3, N = 162] = 35.47, p = < .001), and in the distributions of hospital bed densities between regime type (χ2 [3, N = 159] = 35.31, p = < .001). In all HSA variables, post-hoc Mann-Whitney tests showed significant differences between full democracies and flawed democracies, between full democracies and hybrid regimes, and between full democracies and authoritarian regimes. In all HSA variables, no significant differences were found between hybrid and authoritarian regimes. With multiple least squares regression, the overall models identified the same 2011 EIUDI sub-scores (functioning of government and political participation) as significant for the all of HSA variables, along with region and the interaction between the variables. The regression equations were significant for physician density, adjusted R2 = .551, F(7, 154) = 29.225, p = < .001, nurse density, adjusted R2 = .412, F(7, 154) = 17.090, p = < .001, and hospital bed density, adjusted R2 = .459, F(7, 151) = 20.153, p = < .001. The results from the study and the importance of political issues for nursing are more comprehensively understood by applying the results of the study to the Health Access Livelihood Framework (HALF) developed by Obrist et al. in 2007. The results from this study tested a relational proposition of this framework related to how policies impact HSA. Analyzing the results of this study with the use of this framework allowed for a better realization of the impact that political environment has on HSA. These study findings are of significance to nurses and other health professionals because they examine the political contexts in which citizens access health services, and they help explain the effect political environment has on health. Global health issues are a concern for nurses, and they require nurses to take political action. An initial step for nurses is to understand that global health issues impact everyone across all regions and income levels. In the realization of significant global issues, nurses can take an active role in advocating for solutions to these challenges on a political level. Political engagement is important for nurses living in a globalized world. Nurses can use this information to improve HSA for the people they serve.
DegreeMaster of Nursing (M.N.)
CommitteeBassendowski, Sandra; Holtslander, Lorraine; Szafron, Michael; Reeder, Bruce
Copyright DateMay 2013
Health Services Accessibility