Health inequalities across europe: Do welfare arrangements make a difference?

A puzzle in comparative health inequality research is the finding that egalitarian welfare states do not necessarily demonstrate narrow health inequalities. This paper interrogates into this puzzle by moving beyond welfare regimes to examine how welfare spending, i.e. spending on social benefits/services and health care, affect educational inequalities in self-rated health across Europe. The research question is how welfare spending – operationalised in four different ways – is related to health inequalities in relative and absolute terms. 

 The research question is addressed by analyzing data from the 2005 EU Survey of Income and Living Conditions (EU-SILC) which is a survey data base organized by Eurostat. Our sample includes more than 250 000 individuals (133226 women and 117969 men) aged 25-85+ years from 19 European countries. The four operationalizations of welfare spending were gross and net welfare spending as percentage of GDP, and gross and net welfare spending per capita in purchasing power parities. All four measures were adjusted for “need”, i.e. the size of the population outside the labour market. The data were analyzed by means of multilevel logistic regression and stratified for gender.  

The results show first that welfare expenditures are associated with health inequalities among women, but not among men. Low educated women benefit more from high welfare transfers than middle and high educated women. This means that lower educational inequalities in health – in absolute and relative terms- are linked to higher welfare spending. Next, different operationalisations of welfare spending (i.e. net versus gross, GDP versus per capita) produce very similar outcomes. It appears that a welfare regime approach and an expenditure approach do not necessarily give the same results, and that for women what seem to matter are welfare expenditures, in line with the notion of welfare resources.