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Fiscal decentralization in the Italian NHS: What happens to interregional redistribution?

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  • Ferrario, Caterina
  • Zanardi, Alberto

Abstract

This paper explores how pressures for an increased decentralization of taxing powers to sub-national governments may affect the degree of income redistribution across regional territories accomplished by the Italian NHS. In Italy, political responsibilities for health care are decentralized to regional governments, but the central government retains a critical role in ensuring all citizens uniform access to health services. To this end the central government runs an expenditure needs equalizing system to top up regional governments own resources. However, this system is currently put under question by strong political pressures calling for a weakening of central government involvement. Applying a well developed econometric approach we find that the NHS currently reduces interregional differences in per-capita income by about 7% of GDP. A reform of the NHS in terms of a reduction of expenditure standards produces a weakening of redistribution across jurisdictions, the size of which crucially depends on the financing arrangements of health care that will be actually adopted. We conclude that the decentralization of the NHS would give rise to relevant policy issues concerning in particular the different health care spending possibilities across regions and the impact on the interregional mobility of patients.

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Bibliographic Info

Article provided by Elsevier in its journal Health Policy.

Volume (Year): 100 (2011)
Issue (Month): 1 (April)
Pages: 71-80

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Handle: RePEc:eee:hepoli:v:100:y:2011:i:1:p:71-80

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Web page: http://www.elsevier.com/locate/healthpol

Related research

Keywords: Health care reform Decentralization Regions Interregional redistribution Intergovernmental relations;

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Cited by:
  1. Masayoshi Hayashi, 2013. "On the Decomposition of Regional Stabilization and Redistribution," CIRJE F-Series CIRJE-F-910, CIRJE, Faculty of Economics, University of Tokyo.
  2. Antón, José-Ignacio & Muñoz de Bustillo, Rafael & Fernández-Macías, Enrique & Rivera, Jesús, 2012. "Effects of health care decentralization in Spain from a citizens’ perspective," MPRA Paper 39423, University Library of Munich, Germany.
  3. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
  4. Masayoshi Hayashi, 2012. "Channels of Stabilization in a System of Local Public Health Insurance: The Case of the National Health Insurance in Japan," CARF F-Series CARF-F-280, Center for Advanced Research in Finance, Faculty of Economics, The University of Tokyo.
  5. Revelli Federico, 2012. "Business taxation and economic performance in hierarchical government structures," Department of Economics and Statistics Cognetti de Martiis. Working Papers 201204, University of Turin.
  6. Lagravinese, Raffaele & Paradiso, Massimo, 2012. "Corruption and health expenditure in Italy," MPRA Paper 43215, University Library of Munich, Germany.
  7. Ferrè, Francesca & Cuccurullo, Corrado & Lega, Federico, 2012. "The challenge and the future of health care turnaround plans: Evidence from the Italian experience," Health Policy, Elsevier, vol. 106(1), pages 3-9.
  8. José-Ignacio Antón & Rafael Muñoz de Bustillo & Enrique Fernández Macías & Jesús Rivera, 2014. "Effects of health care decentralization in Spain from a citizens’ perspective," The European Journal of Health Economics, Springer, vol. 15(4), pages 411-431, May.
  9. De Nicola, Arianna & Gitto, Simone & Mancuso, Paolo, 2011. "A two-stage DEA model to evaluate the efficiency of the Italian health system," MPRA Paper 39126, University Library of Munich, Germany.

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