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The stimulative effect of an unconditional block grant on the decentralized provision of care

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  • Mark Kattenberg

    (CPB Netherlands Bureau for Economic Policy Analysis)

  • Wouter Vermeulen

    (CPB Netherlands Bureau for Economic Policy Analysis
    Spatial Economics Research Centre (SERC))

Abstract

Understanding the impact of central government grants on decentralized healthcare provision is of crucial importance for the design of grant systems, yet empirical evidence on the prevalence of flypaper effects in this domain is rare. We study the decentralization of home care in the Netherlands and exploit the gradual introduction of formula-based equalization to identify the effect of exogenous changes in an unconditional block grant on local expenditure and utilization. A one euro increase in central government grants raises local expenditure by twenty to fifty cents. Adjustments occur through the number of hours as well as through substitution between basic and more advanced types of assistance. These findings suggest that conditioning of grants is not required for the central government to retain a moderate degree of control over the decentralized provision of care.

Suggested Citation

  • Mark Kattenberg & Wouter Vermeulen, 2018. "The stimulative effect of an unconditional block grant on the decentralized provision of care," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 25(1), pages 166-199, February.
    • Handle: RePEc:kap:itaxpf:v:25:y:2018:i:1:d:10.1007_s10797-017-9442-7
    DOI: 10.1007/s10797-017-9442-7
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    3. Marenzi, A.; & Rizzi, D.; & Zanette, M.; & Zantomio, F.;, 2022. "Regional Institutional Quality and Territorial Equity in LTC Provision," Health, Econometrics and Data Group (HEDG) Working Papers 22/27, HEDG, c/o Department of Economics, University of York.

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    More about this item

    Keywords

    Intergovernmental transfers; Flypaper effect; Decentralization of health care;
    All these keywords.

    JEL classification:

    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H71 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Taxation, Subsidies, and Revenue
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare

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