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Fiscal Federalism and European Health System Decentralization: A Perspective

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  • Joan Costa-i-Font

Abstract

How 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.

Suggested Citation

  • Joan Costa-i-Font, 2012. "Fiscal Federalism and European Health System Decentralization: A Perspective," LEQS – LSE 'Europe in Question' Discussion Paper Series 55, European Institute, LSE.
    • Handle: RePEc:eiq:eileqs:55
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    Cited by:

    1. Andreas P. Kyriacou & Oriol Roca-Sagalés, 2019. "Local Decentralization and the Quality of Public Services in Europe," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 145(2), pages 755-776, September.
    2. Izabela Rydlewska-Liszkowska, 2015. "Publiczne i prywatne finansowanie ochrony zdrowia – mo¿liwoœci i ograniczenia analizy na poziomie regionalnym (Publiczne i prywatne finansowanie ochrony zdrowia – mozliwoœci i ograniczenia analizy na ," Problemy Zarzadzania, University of Warsaw, Faculty of Management, vol. 13(53), pages 165-180.
    3. Cavalieri, Marina & Ferrante, Livio, 2016. "Does fiscal decentralization improve health outcomes? Evidence from infant mortality in Italy," Social Science & Medicine, Elsevier, vol. 164(C), pages 74-88.

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    More about this item

    Keywords

    health systems decentralisation; fiscal federalism; health care; political agency;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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