The uneven geography of the health system and its effect on the individual probability of death by COVID-19

The COVID-19 pandemic caused many life losses, which were not uniform across territories. Several factors can explain geographical differences, including the health and sanitary infrastructure and the economic performance. The present study seeks to determine the probability of death by COVID-19 of individuals by analyzing their individual and contextual characteristics related to their canton of residence with emphasis on the structure of the health system. Using combined data at the individual and contextual level, a logit multilevel model is estimated. The results show that cantonal differences explain 12.8–22.6% of the total variance of the individual probability to die. Cantons where people were more likely and less likely to die by stage were identified. Level 1 health care centers played an important role in reducing the probability of death by COVID-19 of individuals from the isolation stage to the vaccination stage.