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Fiscal decentralisation and infant mortality rate: The Colombian case

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  • Soto, Victoria Eugenia
  • Farfan, Maria Isabel
  • Lorant, Vincent

Abstract

There is a paucity of research analysing the influence of fiscal decentralisation on health outcomes. Colombia is an interesting case study, as health expenditure there has been decentralising since 1993, leading to an improvement in health care insurance. However, it is unclear whether fiscal decentralisation has improved population health. We assess the effect of fiscal decentralisation of health expenditure on infant mortality rates in Colombia. Infant mortality rates for 1080 municipalities over a 10-year period (1998–2007) were related to fiscal decentralisation by using an unbalanced fixed-effect regression model with robust errors. Fiscal decentralisation was measured as the locally controlled health expenditure as a proportion of total health expenditure. We also evaluated the effect of transfers from central government and municipal institutional capacity. In addition, we compared the effect of fiscal decentralisation at different levels of municipal poverty. Fiscal decentralisation decreased infant mortality rates (the elasticity was equal to −0.06). However, this effect was stronger in non-poor municipalities (−0.12) than poor ones (−0.081). We conclude that decentralising the fiscal allocation of responsibilities to municipalities decreased infant mortality rates. However, this improved health outcome effect depended greatly on the socio-economic conditions of the localities. The policy instrument used by the Health Minister to evaluate municipal institutional capacity in the health sector needs to be revised.

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  • Soto, Victoria Eugenia & Farfan, Maria Isabel & Lorant, Vincent, 2012. "Fiscal decentralisation and infant mortality rate: The Colombian case," Social Science & Medicine, Elsevier, vol. 74(9), pages 1426-1434.
    • Handle: RePEc:eee:socmed:v:74:y:2012:i:9:p:1426-1434
    DOI: 10.1016/j.socscimed.2011.12.051
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    12. Leonardo Letelier S. & Héctor Ormeño, 2018. "El mapa de la descentralización fiscal en Chile," Journal Economía Chilena (The Chilean Economy), Central Bank of Chile, vol. 21(3), pages 004-040, December.
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    14. André Martínez Fritscher & Carolina Rodríguez Zamora, 2016. "An Evaluation of the 1997 Expenditure Decentralization Reform in Mexico," Public Finance Review, , vol. 44(5), pages 563-588, September.
    15. Raju Mainali, 2021. "Spatial Fiscal Interactions in Colombian Municipalities: Evidence from Oil Price Shocks," JRFM, MDPI, vol. 14(6), pages 1-15, June.
    16. Manzoor Ahmed & Abdul Qayyum, 2023. "Decentralisation’s Effects on Health: Theory and Evidence from Balochistan, Pakistan," The Pakistan Development Review, Pakistan Institute of Development Economics, vol. 62(3), pages 331-356.
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