Published: 2021-08-27

Determinants of healthcare quality in single-payer healthcare system countries

Nouf S. Al Saied, Musaed S. Al Ali


Background: The quality of healthcare system in any country is essential for the wellbeing of its population. Improving the quality of the healthcare sector would lead to a healthier population and thus more productive nation and stronger economy. The level of healthcare quality depends on both economic and non-economic factors. Addressing the level of effect these factors on healthcare quality would facilitate policy makers’ tasks in achieving that goal.

Method: This study is based on the 2019 data of 29 countries that adapt single-payer healthcare system. Pearson correlation matrix is used to examine the relation of a number of variables with healthcare quality, measured by life expectancy, in these countries.

Results: The results from this research showed that literacy rate, digital adaptation, pollution level, corruption level, healthcare expenditure (HE) per capita, GDP per capita, healthcare expenditure as a percentage of GDP all showed a strong relation at the 99% confidence level while the number of physicians per 1000 showed statistically significant relation with healthcare quality at the 95% confidence level. While all factors showed direct relation, pollution and corruption showed an inverse relation.

Conclusions: Improving the quality of the healthcare sector is the goal of any government since it would lead to better and stronger economy. While economic factors play a role in achieving that goal, other non-economic factors can also have the same effect in achieving that goal. 


Single-payer healthcare system, Healthcare quality, Life expectancy, HE, Pollution, Corruption

Full Text:



Gulis G. Life expectancy as an indicator of environmental health. Eur J Epidemiol. 2000;16:161-5.

Kaufmann D, Kraay A, Mastruzzi M. Governance matters: governance indicators for 1996–2002. World Bank policy res department, 2003;3106.

Deshpande N, Kumar A, Ramawami R. The Effect of National Healthcare Expenditure on Life Expectancy. Georgia Institute of Technology. 2014. Available at;jsessionid=AE5D19255A0CB9474AFECD086C5D1297.smartech?sequence=1. Accessed on 5 March 2020.

Jaba E, Balan JB, Robu IB. The relationship between life expectancy at birth and health expenditures estimated by a cross-country and time-series analysis. Procedia Economics Finance. 2014;15;108-14.

Chetty R, Stepner M, Abraham S, Lin S, Scuderi B, Turner N et al. The Association between Income and Life Expectancy in the United States, 2001-2014. JAMA. 2016;315(16):1750-66.

Grubaugh SG, Santerre RE. Comparing the Performance if Health Care Systems: An Alternative Approach. Southern Economic J. 1994;60(4):1030-42.

Boachie M, Ramu K. Effect of public health expenditure on health status in Ghana. Int J Health. 2016;4(1):6-11.

Messias E. Income inequality, illiteracy rate, and life expectancy in Brazil. Am J Public Health. 2003;93:1294-6.

Lleras-Muney A, Sherry G. Health Inequality. Education and Medical Innovation. Demography. 2008;45(3):741-61.

Pak Hung MO. Corruption and Economic Growth. J Comparative Economics. 2001;29(1):66-79.

Das J, Di Rienzo C. The nonlinear impact of globalization on corruption. Int J Business Finance Res. 2009;3(2):33-46.

Mauro P. The Persistence of corruption and slow economic growth. IMF. 2002;WP/02/213.

Gupta S, Verhoeven N, Tiongson E. Public Spending on Health Care and the Poor. Health Economics. 2003;12(8):685-96.

World Health Organization 2020 data: Available at: Accessed on 5 March 2020.

Ebenstein, Avraham, Fan M, Greenstone M, He G, Yin P, Zhou M. Growth, Pollution, and Life Expectancy: China from 1991-2012. Am Economic Review. 2015;105(5):226-31.

Correia AW, Pope CA 3rd, Dockery DW, Wang Y, Ezzati M, Dominici F. Effect of air pollution control on life expectancy in the United States: an analysis of 545 U.S. counties for the period from 2000 to 2007. Epidemiology (Cambridge, Mass.). 2013;24(1):23-31.

Herrera CA, Rada G, Kuhn-Barrientos L, Barrios X. Does Ownership Matter? An Overview of Systematic Reviews of the Performance of Private For-Profit, Private Not-For-Profit and Public Healthcare Providers. PLoS one. 2014;9(12):e93456.