Countries with high levels of economic freedom have better healthcare

Martin van Staden / Midjourney
Martin van Staden / Midjourney

This article was first published by City Press on 31 May 2024 (paywalled)

Economic freedom is the fundamental right of every individual to personally control their labour and property. This level of personal control benefits all aspects of their lives including healthcare.

Countries with high levels of economic freedom enjoy vastly superior healthcare. The current nationalisation of South Africa’s private healthcare will therefore have tragic consequences that will negatively affect the lives of every individual and family that is forcefully deprived of control over their healthcare. Healthcare outcomes such as infant mortality rates and life expectancy, clearly illustrate the connection between economic freedom and healthcare.

Infant mortality rates

Lower infant mortality in economically free countries

High economic freedom leads to low levels of infant mortality. Countries that enjoy increased economic freedom have low levels of infant mortality. For instance, Singapore, with an economic freedom score of 8.56 out of 10 in the Fraser Institute Economic freedom of the World Report 2023, has one of the lowest infant mortality rates globally at 1.9 deaths per 1,000 live births. Similarly, Switzerland with an economic freedom score of 8.47 has an infant mortality rate of just 3.0 deaths per 1,000 live births.

South Africa by contrast has an economic freedom score of 6.53. The infant mortality rate in South Africa is more than 12 times that of Singapore’s at 24.1 deaths per 1,000 live births in 2023.

Life expectancy

Longer life expectancy in economically free nations

Economic freedom comparisons also reveal a direct link to increased life expectancy. In more economically free countries such as Switzerland, with an economic freedom score of 8.42, the average life expectancy is 84.52 years. Singapore also enjoys a high life expectancy of 84.39 years due to its strong economic freedom rating and good healthcare system​.

South Africans die, on average, 20 years younger than Swiss or Singaporeans with a life expectancy of only 64.1 years​​. This reflects our ongoing healthcare challenges in South Africa exacerbated by lower economic freedom having a clearly negative impact on the efficiency and cost of healthcare services.

The effect of economic freedom on healthcare

Extensive research has revealed that where the environment in which the healthcare system operates is supported by economic freedom, the quality of the healthcare delivered is higher and the life expectancy of the people is greater. Diverse ways are used in the freer economies to improve healthcare outcomes:

  • Incentives to innovate: Free markets inspire innovations from healthcare providers and firms. In Switzerland and Singapore, competition promotes the discovery of new medical technology and treatments that improve healthcare overall.
  • Efficient resource allocation: Economic freedom ensures that resources are allocated to meet market needs rather than arbitrary political dictates. This reduction of waste means that better use can be made of healthcare funds.
  • Better quality of care: In a free market, competition elevates the overall quality of services offered to patients because healthcare providers strive to deliver high-quality services at lower costs.
  • Economic growth: Economic freedom brings about economic growth and therefore higher per capita incomes. Switzerland and Singapore are leading examples of developed countries with higher budgets for basic infrastructure, research, and various services due to their better ability to spend more on health.

Economic freedom is critical for producing advanced quality healthcare. Countries high in economic freedom, show that personal choice, voluntary cooperation, market competition and secure property rights promote an environment with better healthcare. These countries have low infant mortality rates and high life expectancies. The situation in South Africa is different; lower economic freedom has resulted in poor overall healthcare being available to the average citizen. Improving economic freedom should be a priority for policymakers. The relationship between economic freedom and better healthcare services for all is clear and compelling and the NHI legislation is taking us in the wrong direction.


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The views expressed in the article are the author’s and are not necessarily shared by the members of the Foundation. This article may be republished without prior consent but with acknowledgement to the author.




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