Project A04 (2022-25)

Global Developments in Health Care Systems

In the second phase of the CRC 1342, project A04 pursues three research goals: first, to describe the evolution of coverage and generosity in healthcare systems worldwide from inception to the present; second, to identify and explain the temporal and spatial patterns of inclusion, exclusion and benefit dynamics; and third, to explore the role of specific causal mechanisms to explain the findings of the project’s first phase concerning the timing and emergence of specific healthcare system types in select countries. 

The description of coverage and generosity will be achieved using categorical and numeric indicators. Numeric data will mainly be drawn from international and national databases, whereas categorical data will rely on archival sources and involve document analysis supported by hybrid-AI software (in collaboration with the CRC INF-Team).

The temporal and spatial patterns of inclusion, exclusion, and benefit dynamics will be identified and explained using macro quantitative methods, particularly regression analysis. The main assumptions guiding this research include: (1) dynamics can be partly attributed to the type of healthcare system existing in a country; (2) expansion thrusts in one country increase the probability of a corresponding thrust in another country if the two are strongly linked (horizontal linkages); and (3) the World Health Organization, with its "health for all" priority, causes expansion trends in both coverage and generosity that show up as a period effect on the one hand, but also as catch-up expansion and an upward alignment on the other, while the influence of the World Bank tends to have a contractionary effect (vertical linkages).

Case study research will be conducted on two former British colonies, Nigeria and Kenya, to explore findings from the first phase of the project that pointed to the role of political independence and ensuing nation building processes as factors contributing to healthcare system introductions. More specifically, we will compare developments in the two countries using process tracing that relies on intensive archival research, primary data collection through expert interviews, as well as secondary literature. Our case selection of Kenya and Nigeria reflect an interest in comparative developments in two countries that differ greatly in the timing of their healthcare system introductions and their adoption of system types despite similar background conditions (i.e., timing of political independence and economic development).