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Devolution and the Interregional Inequalities in Health and Healthcare in Spain

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  • Joan Costa-Font
  • Ana Rico

Abstract

Costa-Font J. and Rico A. (2006) Devolution and the interregional inequalities in health and healthcare in Spain, Regional Studies 40, 875-887. The desirability of devolution of government responsibilities is often questioned on the grounds of regional cohesion concerns. This feature is especially relevant in welfare policy areas such as healthcare services given their impact on an individual's well-being. This paper examines the effects of health system devolution on the emergence of inter-territorial inequalities in healthcare outcomes (mortality) and outputs (healthcare expenditure) in the Spanish National Health System (NHS). Based on an empirical model for regional health expenditure, and drawing from a battery of inequality indicators (some taken from previous studies, other estimated anew), the following results are obtained. First, healthcare devolution has not led to an expansion of regional inequalities in healthcare outcomes and outputs. Second, there is no clear-cut evidence that devolution increases public health expenditure (in real terms) in devolved region-states, with the exception of fiscally accountable autonomous communities (ACs). Finally, regional health expenditure is explained by differences in need and higher reliance healthcare inputs use, size effects as well as the region-specific economic and demographic dimension in addition to regional income. Costa-Font J. et Rico A. (2006) La regionalisation et les inegalites de sante et des services medicaux en Espagne, Regional Studies 40, 875-887. Souvent on remet en question les avantages de la regionalisation des competences gouvernementales en raison des questions qui se posent quant a la cohesion regionale. Cela est particulierement pertinent dans le domaine des politiques en faveur des services medicaux, etant donne leur impact sur le bien-etre de l'individu. Cet article cherche a examiner les retombees de la regionalisation des services de sante sur la naissance des inegalites des resultats des services medicaux (mortalite) et des rendements (depenses de sante) dans la Securite Sociale espagnole. A partir d'un modele econometrique des depenses de sante, et puisant dans une batterie d'indices d'inegalite (dont certains proviennent des etudes anterieures et dont d'autres sont de nouvelles estimations), on obtient les resultats suivants. Primo, la regionalisation des services medicaux n'a entraine un creusement des inegalites regionales ni des resultats, ni des rendements des services medicaux. Secundo, il reste a prouver que la regionalisation augmente les depenses de sante publique (en termes reels), a l'exception des AC qui sont fiscalement autonomes. Pour conclure, on explique les depenses de sante regionales en termes du besoin et de l'utilisation des facteurs medicaux dont on depend davantage, des effets de taille ainsi que des dimensions economique et demographique specifiques d'une region en plus du revenu regional. Inegalites regionales Interactions politiques Responsabilite politique Secu Costa-Font J. und Rico A. (2006) Dezentralisierung und die von Region zu Region zu beobachtenden Unterschiede der Gesundheit und Gesundheitsfursorge in Spanien, Regional Studies 40, 875-887. Auf Grund der Besorgnis um regionale Kohasion fragt man sich oft, ob die Dezentralisierung der Regierungsverantwortlichkeit wunschenswert ist. In Anbetracht der Auswirkung auf das Wohlergehen individueller Personen betrifft dieser Aspekt besonders Aufgabengebiete derWohlfahrtspolitik, wie z.B. Gesundheitsfursorge. DieserAufsatz untersucht die Wirkung der Dezentralisierung des Gesundheitswesens auf von Region zu Region beobachteten Unterschieden in den Ergebnissen der Gesundheitsfursorge (Sterblichkeit) und Aufwand (Ausgaben fur Gesundheitsfursorge) im Gesundheitswesen des spanischen Staates (NHS). Gestutzt sowohl auf ein empirisches Modell fur regionale Gesundheitsausgaben als auch eine Reihe Unterschiedsindikatoren (manche fruheren Studien entnommen, andere von neueren Berechnungen) werden folgende Ergebnisse erzielt:erstens, dass die Dezentralisierung der Gesundheitsfursorge nicht zu einer Ausweitung regionaler Unterschiede der Ergebnisse der Gesundheitsfursorge gefuhrt hat, und zweitens sich keine eindeutigen Beweise ergaben, dass Dezentralisierung die Ausgaben fur das offentliche Gesundheitswesen mit Ausnahme des finanziell verantwortlichen AC in zentralierten Regionalstaaten (effektiv)gestiegen sind. Abschliessend werden regionale Ausgaben fur das Gesundheitswesen zusatzlich regionler Einkommen durch Unterschiede in Bedarf und grosserem Verlass auf Inanspruchnahme des Gesundheitsfursorgeaufwands, durch Grosseneffekte sowie spezifische wirtschaftliche und demographische Dimensionen erklart. Regionale Unterschiede Politische Wechselwirkungen Politische Verantwortlichkeit NHS Costa-Font J. y Rico A. (2006) Transferencia de competencias y las desigualdades interregionales en la salud y la atencion sanitaria en Espana, Regional Studies 40, 875-887. A menudo se cuestiona la conveniencia de la transferencia de las competencias del gobierno porque se teme que peligre la cohesion regional. Esta cuestion es especialmente relevante en temas de la politica del bienestar tales como los servicios de atencion sanitaria, puesto que tienen mucho impacto en el bienestar del individuo. En este articulo examinamos que efectos ha tenido la transferencia de competencias del sistema de la salud en cuanto a la aparicion de desigualdades interterritoriales en los resultados de la atencion sanitaria (mortalidad) y la inversion (gasto de la atencion sanitaria) en el sistema de la Seguridad Social en Espana. Basandonos en un modelo empirico para el gasto de la salud en las comunidades autonomas y segun una bateria de indicadores de desigualdades (algunos extraidos de estudios previos, y otros de calculos nuevos), obtenemos los siguientes resultados. Primero, la transferencia de la competencia de atencion sanitaria no ha llevado a una expansion de las desigualdades regionales en los resultados y las inversiones. Segundo, no hay pruebas claras de que la transferencia de competencias aumente el gasto de la salud publica (en terminos reales) en los estados regionales con las competencias transferidas con la excepcion de una contabilidad fiscalmente responsable. Para terminar, el gasto de la salud en las comunidades autonomas se explica por las diferencias en las necesidades y una mayor dependencia de la atencion sanitaria, los efectos del tamano asi como la dimension economica y demografica de la region en cuestion, ademas de los ingresos regionales. Desigualdades regionales Interacciones politicas Responsabilidad politica Seguridad Social

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Bibliographic Info

Article provided by Taylor & Francis Journals in its journal Regional Studies.

Volume (Year): 40 (2006)
Issue (Month): 8 ()
Pages: 875-887

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Handle: RePEc:taf:regstd:v:40:y:2006:i:8:p:875-887

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Related research

Keywords: Regional inequalities; Political interactions; Political accountability; Spanish National Health System (NHS);

References

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  1. Federico Revelli, 2001. "Spatial patterns in local taxation: tax mimicking or error mimicking?," Applied Economics, Taylor & Francis Journals, vol. 33(9), pages 1101-1107.
  2. SALMON, Pierre, 1987. "Decentralization as an incentive scheme," Institut des Mathématiques Economiques – Document de travail de l’I.M.E. (1974-1993) 98, Institut des Mathématiques Economiques. LATEC, Laboratoire d'Analyse et des Techniques EConomiques, CNRS, Université de Bourgogne.
  3. Guillem López & Joan Costa-Font & Ivan Planas, 2004. "Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'," Working Papers, Research Center on Health and Economics 745, Department of Economics and Business, Universitat Pompeu Fabra.
  4. Federico Revelli, 2002. "Testing the taxmimicking versus expenditure spill-over hypotheses using English data," Applied Economics, Taylor & Francis Journals, vol. 34(14), pages 1723-1731.
  5. Costa-Font, J.; & Hernandez-Quevedo, C.;, 2013. "Inequalities in Self-Reported Health: A Meta-Regression Analysis," Health, Econometrics and Data Group (HEDG) Working Papers 13/05, HEDG, c/o Department of Economics, University of York.
  6. Besley, Timothy & Case, Anne, 1995. "Incumbent Behavior: Vote-Seeking, Tax-Setting, and Yardstick Competition," American Economic Review, American Economic Association, vol. 85(1), pages 25-45, March.
  7. Rubinfeld, Daniel L., 1987. "The economics of the local public sector," Handbook of Public Economics, in: A. J. Auerbach & M. Feldstein (ed.), Handbook of Public Economics, edition 1, volume 2, chapter 11, pages 571-645 Elsevier.
  8. Joan Costa-Font & Ana Rico, 2006. "Vertical Competition in the Spanish National Health System (NHS)," Public Choice, Springer, vol. 128(3), pages 477-498, September.
  9. Joan Costa & Jaume Garcia, 2003. "Demand for private health insurance: how important is the quality gap?," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 587-599.
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Cited by:
  1. Giardina, Emilio & Cavalieri, Marina & Guccio, Calogero & Mazza, Isidoro, 2009. "Federalism, Party Competition and Budget Outcome: Empirical Findings on Regional Health Expenditure in Italy," MPRA Paper 16437, University Library of Munich, Germany.
  2. Joan Costa Font & Jordi Pons Novell, 2005. "Public Health Expenditure and Spatial Interactions in a Decentralized National Health System," Working Papers in Economics 139, Universitat de Barcelona. Espai de Recerca en Economia.
  3. Masayoshi Hayashi, 2011. "The effects of medical factors on transfer deficits in Public Assistance in Japan: a quantile regression analysis," International Journal of Health Care Finance and Economics, Springer, vol. 11(4), pages 287-307, December.
  4. 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.
  5. Bech, Mickael & Lauridsen, Jørgen, 2008. "Exploring the spatial pattern in hospital admissions," Health Policy, Elsevier, vol. 87(1), pages 50-62, July.
  6. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Care Finance and Economics, Springer, vol. 10(3), pages 219-237, September.

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