Governance models and pandemic outcomes

Purpose : This paper explores the anti-epidemic policies of Italy, Germany, and Sweden in response to the COVID-19 pandemic in the period 2020–2022. The degree of decentralization, the stringency index, and the universal health coverage (UHC), expressed as the percentage of the gross domestic product (GDP), present distinguishing characteristics of the three crisis management models, making them essential for exploring their correlation with excess mortality. Methodology : The mixed-method approach is used in this research. The study uses a qualitative cross case design, incorporating countries with various combinations of key factors, allowing for the analysis of the causes of outcome variation. Given the temporal heterogeneity of independent variables, the quantitative analysis relies on the Mixed Data Sampling (MIDAS) regression model. Results: The MIDAS regression analysis of excess mortality shows a statistically significant positive correlation with both average population age and healthcare expenditure, where the latter is contrary to expectations. GDP per capita and the proportion of women in total population are negatively correlated with excess mortality. In this sample, UHC and daily stringency indices are not statistically significant, indicating no detected association with excess mortality. Conclusion: The presented analysis of Italy, Germany, and Sweden affirms that the demographics and the economic capacity, as opposed to the stringency index, shape excess mortality. The null effect for UHC and the surprising direction of the health-spending estimate suggest that the governance and productivity of resources matter more for pandemic performance than the magnitude of the budget.