Speakers - 2027

Title: Multi-dimensional scaling of healthcare system profiles and pandemic outcomes

Abstract

COVID-19 produced severe health and economic disruptions across countries, with especially strong effects on vulnerable groups, public health systems, and social protection structures . In Europe, the pandemic was associated with substantial excess mortality and marked geographic disparities, which were shaped not only by epidemiological conditions but also by inequality, institutional capacity, and the organization of care  Within this broader context, the present study examines how pre-pandemic health risks and healthcare system structures shaped COVID-19 outcomes in Cuba, Spain, Italy, and Germany.The analysis applies Multi-Dimensional Scaling (MDS) to connect baseline vulnerabilities with pandemic trajectories. This choice follows a well-established tradition in exploratory multivariate analysis, where MDS is used to reveal latent proximity structures in complex data. Unlike studies that concentrate mainly on expenditure, hospital capacity, or income, this approach combines structural health risks with the temporal evolution of the pandemic. Existing comparative work on health-system efficiency has already shown that parsimonious demographic and epidemiological indicators can be highly informative. In the specific context of COVID-19, age structure, comorbidities, and institutional effectiveness have also been found to matter for cross-country differences in outcomes. The four countries considered here represent distinct institutional models. Cuba follows a state-socialist model, Spain and Italy belong to the Mediterranean branch of tax-financed systems, and Germany represents a corporatist Bismarckian model. Prior research has questioned whether the Beveridge and Bismarck traditions produce systematically different performance outcomes, especially under crisis conditions. The comparison is therefore useful because it brings together contrasting institutional designs while focusing on a common pandemic shock.