Abstract
BACKGROUND:
The
past decade has witnessed a growing body of research on welfare state
characteristics and health inequalities but the picture is, despite
this, inconsistent. We aim to review this research by focusing on
theoretical and methodological differences between studies that at least
in part may lead to these mixed findings.
METHODS:
Three
reviews and relevant bibliographies were manually explored in order to
find studies for the review. Related articles were searched for in
PubMed, Web of Science and Google Scholar. Database searches were done
in PubMed and Web of Science. The search period was restricted to
2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria.
RESULTS:
Three
main approaches to comparative welfare state research are identified;
the Regime approach, the Institutional approach, and the Expenditure
approach. The Regime approach is the most common and regardless of the
empirical regime theory employed and the amendments made to these,
results are diverse and contradictory. When stratifying studies
according to other features, not much added clarity is achieved. The
Institutional approach shows more consistent results; generous policies
and benefits seem to be associated with health in a positive way for all
people in a population, not only those who are directly affected or
targeted. The Expenditure approach finds that social and health spending
is associated with increased levels of health and smaller health
inequalities in one way or another but the studies are few in numbers
making it somewhat difficult to get coherent results.
CONCLUSIONS:
Based
on earlier reviews and our results we suggest that future research
should focus less on welfare regimes and health inequalities and more on
a multitude of different types of studies, including larger analyses of
social spending and social rights in various policy
areas and how these are linked to health in different social strata.
But, we also need more detailed evaluation of specific programmes or
interventions, as well as more qualitative analyses of the experiences
of different types of policies among the people and families that need
to draw on the collective resources.
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