Money matters: The association between blood donation rates and healthcare system quality across 171 countries.

Abstract

Worldwide, insufficient blood donations cause blood shortages that jeopardize vital medical treatments for patients. Blood donation rates vary widely across countries, yet the determinants of this variation remain poorly understood. This study aims to illuminate the role of the institutional context in which blood donation is embedded by examining the link between country-level blood donation rates and healthcare system quality. The study employed a cross-sectional design using data on blood donation rates from 171 countries from the 2021 WHO Global Status Report on Blood Safety and Availability and three healthcare quality indicators (i.e., Healthcare Access and Quality [HAQ] Index, life expectancy, and health expenditures). The pre-registered hypotheses are tested using multiple linear regression. Robustness checks control for confounding factors. HAQ Index and health expenditures are positively associated with blood donation rates, whereas life expectancy is not related to blood donation when controlling for confounds. Health expenditures display the most robust association with blood donations, even when controlling for confounding factors, and when comparing countries within the same continent. Higher healthcare system quality in terms of HAQ Index and higher healthcare expenditures are related to higher blood donation rates. The finding that healthcare expenditures are most consistently related to blood donation rates indicates that policymakers should consider prioritizing financial support for the healthcare system, including blood-collecting institutions. More broadly, a better understanding of the role of contextual factors for blood donation may be needed to increase blood availability worldwide.