Document Type

Conference Proceeding

Publication Date

Summer 6-3-2025

Keywords

COVID-19, institutional change, government financing trends, political authority, decentralization, public health financing, healthcare systems responsibility, critical juncture

Abstract

This paper investigates whether the COVID-19 pandemic functioned as a critical juncture that led to lasting institutional change in government health investment. Using an original comparative framework, the analysis explores changes in health financing across ten OECD countries classified by Reibling et al.'s five-type typology of healthcare systems. We assess shifts in public, private, and government health expenditure before, during, and after the pandemic, using both descriptive and visual data. Our findings suggest that while nearly all countries increased government and public shares of health spending during the pandemic, the persistence of these changes varied by system type, GDP level, and institutional configurations of authority, responsibility, and accountability. High-income countries with strong accountability mechanisms, such as Canada and Denmark, maintained increased health investment post-crisis. In contrast, countries like Hungary and Slovenia reverted to pre-pandemic patterns, often due to weak public demand or financial constraints. Type 3 and 4 systems demonstrated greater resistance to structural change, while type 5 systems, despite private-sector dominance, saw notable increases in public investment. Our results underscore how institutional design and fiscal capacity jointly determine whether crisis-induced shifts in policy become entrenched or merely temporary, providing insight into the conditions for durable health system reform.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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