Spaces of equality: The political economy of universal healthcare (PhD thesis)

Centered around the overarching themes of expanding research focus to the Global South and conceptualizing universal healthcare as a 'space of equality,' this research project aims to address three key research questions:

Research Question 1: Are there systematic differences in the consequences and determinants of universal healthcare between the Global North and the Global South?

Research Question 2: How does universal healthcare influence citizens' sense of social cohesion and confidence in public institutions, and how do these factors relate to public support for redistribution?

Research Question 3: How do democracy, electoral competition, and party ideology impact the adoption and expansion of universal healthcare systems?

To answer these questions, the thesis follows an article-based structure comprising three research papers. The first paper, titled "The Role of Healthcare Universalism in Advancing Human Security," explores the relationship between healthcare universalism and human security through an empirical analysis spanning 195 countries from 1995 to 2017. Introducing the Healthcare Universalism Index (HUI), it combines three dimensions: coverage, generosity, and equity. The paper assesses the global development of healthcare universalism and examines its association with infectious diseases, poverty, inequality, violence, and conflict, particularly focusing on the 'paradox of redistribution.'

The second paper, "Spaces of Equality: Healthcare Universalism, Social Cohesion, and Support for Redistribution," investigates the contribution of universalism to individual perceptions of social cohesion. It conceptualizes universal healthcare as a 'space of equality,' shaping citizens' relationships with the state and society. Empirically tested using multilevel regression models with data from the World Values Survey (WVS) and the European Values Study (EVS), this paper explores universal healthcare as a potential tool for strengthening social cohesion and societal space for community- and nation-building. It quantifies effects on social cohesion, trust in public institutions, and their relationship to public support for redistribution.

Lastly, the third paper, "Beyond Democracy: The Political Determinants of Universal Healthcare Reform," examines the role of enabling political conditions in building universal healthcare systems. Focusing on regime type, electoral competition, and party ideology, the paper analyzes specific features of democratic political institutions that support the adoption and expansion of universal policies. In a quantitative and global analysis, it systematically examines the influence of left-wing political forces as agents for policy reform and contrasts it with other political-institutional determinants, namely regime type and electoral competition.