available through

http://www.sciencedirect.com/science?_ob=IssueURL&_tockey=%23TOC%235882%239999%23999999999%2399999%23FLA%23&_auth=y&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=cfb513648cea0765ef24343b45639d5c
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Welfare state matters: A typological multilevel analysis of wealthy
countries

Haejoo Chunga, ,  and Carles Muntanerb

aDepartment of Health Policy and Management, Johns Hopkins School of Public
Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
bSocial Equity and Health Section, Social Policy and Prevention Department,
Center for Addictions and Mental Health, and Faculty of Nursing, Department
of Public Health Sciences, and Department of Psychiatry, University of
Toronto, 250 College St. Toronto, Ont., Canada M5T 1R8

Available online 5 May 2006.

Abstract
Building on the social science literature, we hypothesized that population
health indicators in wealthy industrialized countries are ‘clustered’
around welfare state regime types. We tested this hypothesis during a
period of welfare state expansion from 1960 to 1994. We categorized data
from 19 wealthy countries into 4 different types of welfare state regimes
(Social Democratic, Christian Democratic, Liberal and Wage Earner Welfare
States). Outcome variables were the infant mortality rate (IMR) and the low
birth weight rate (LBW), obtained from the Organization of Economic
Co-operation and Development (OECD) Health Data 2000 and from the United
Nations Common Statistical Database (UNCSD). A two-level multilevel model
was constructed, and fixed effects of welfare state were tested. Through
the 39 years analyzed, Social Democratic countries exhibited a
significantly better population health status, i.e., lower infant mortality
rate and low birth weight rate, compared to other countries. Twenty percent
of the difference in infant mortality rate among countries could be
explained by the type of welfare state, and about 10% for low birth weight
rate. The gap between Social Democracies and other countries widened over
the 1990s. Our results confirm that countries exhibit distinctive levels of
population health by welfare regime types even when adjusted by the level
of economic development (GDP per capita) and intra-country correlations. It
implies that countries, as groups, adopt similar policies or through any
other ways, achieve similar level of health status. Proposed mechanisms of
such process and suggestions for future research directions are presented
in the discussion.

Keywords: Welfare state; Low birth weight rate; Infant mortality rate;
Neo-liberal reform

Corresponding author. Tel.: +1 443 527 6298.

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