Fiscal Federalism and European Health System Decentralization: A Perspective
AbstractHow does fiscal decentralisation affect the development of a health system?Evidence from health care decentralisation in Europe can offer some insights to the question above. This paper addresses the effects of health care decentralisation in Europe, and reviews some of the key questions on the design of a health system. We argue that contrary to old mobility argument, the effects of health care decentralisation result from tighter political agency, which generally stands as an alternative to health care privatisation. However, whether efficiency improves after a process of decentralisation depends heavily on the incentives fiscal design exerts on cost –containment, inter-jurisdictional competition, policy innovation and diffusion. Experiences of health care decentralisation highlight important concerns associated with vertical imbalances and limited horizontal imbalances. Finally, health care decentralisation can give rise to a new regional political cycle where citizens can reward or penalise the performance of health policy.
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Bibliographic InfoPaper provided by European Institute, LSE in its series LEQS – LSE 'Europe in Question' Discussion Paper Series with number 55.
Date of creation: Dec 2012
Date of revision:
health systems decentralisation; fiscal federalism; health care; political agency;
Other versions of this item:
- Joan Costa-i-Font, 2012. "Fiscal Federalism and European Health System Decentralization: A Perspective," Europe in Question Discussion Paper Series of the London School of Economics (LEQs) 5, London School of Economics / European Institute.
- H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
- I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
This paper has been announced in the following NEP Reports:
- NEP-ALL-2013-01-19 (All new papers)
- NEP-HEA-2013-01-19 (Health Economics)
- NEP-POL-2013-01-19 (Positive Political Economics)
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