The impact of public healthcare system on COVID-19 mortality rate in selected European and South Caucasian countries

This study investigated the relationship between public healthcare-related features, vaccination rates, and COVID-19 mortality rates in 44 European and South Caucasian countries. The COVID-19 mortality rates were averaged from 21 November 2021 to 4 December 2021, coinciding with the height of the fourth wave of the pandemic. A cross-sectional analysis was conducted using the ordinary least squares (OLS) estimator, the spatial autoregressive (SAR) model, and the spatial error (SEM) model. A cluster analysis was then performed to identify homogeneous groupings of nations exhibiting escalating risk variables for COVID-19 mortality. The results indicated that public health expenditure, healthcare personnel, pharmacists, universal health coverage (UHC), and COVID-19 vaccination rates exhibited significant negative correlations with COVID-19 mortality rates, while out-of-pocket (OOP) spending and the saturation of ordinary and intensive care unit (ICU) beds demonstrated significant positive correlations with COVID-19 mortality rates. Cluster analysis indicated that post-communist and post-Soviet European nations with more decentralized and predominantly private insurance-based healthcare systems exhibited the highest risk variables for COVID-19 mortality. In contrast, Nordic European countries with universal healthcare systems demonstrated the lowest risk. Consequently, nations with publicly funded comprehensive healthcare systems have shown greater efficacy in reducing COVID-19 death rates while alleviating the strain on national healthcare systems. These policy recommendations may be beneficial in the event of similar shocks in the future.