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Effects of health care decentralization in Spain from a citizens’ perspective

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  • Antón, José-Ignacio
  • Muñoz de Bustillo, Rafael
  • Fernández-Macías, Enrique
  • Rivera, Jesús

Abstract

The aim of this article is to analyze the impact of the decentralization of the public national health system in Spain on citizens’ satisfaction with different dimensions of primary and hospital care. Using micro-data from the Health Barometer 1996-2009 and taking advantage of the exogeneity of the different pace of decentralization across Spain, we find that, in general, decentralization has not improved citizens’ satisfaction with different features of the health services. In fact, the only significant -though small- effects found were of the opposite sign, i.e., a reduction in satisfaction as a result of decentralization, regarding the following aspects of medical care: assistance in the primary care centers, waiting time before consultation, ease of getting appointments, confidence transmitted by doctors and the number of persons per hospital room.

Suggested Citation

  • 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.
    • Handle: RePEc:pra:mprapa:39423
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    Cited by:

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    2. Leonardo E. Letelier-S & José L. Sáez-Lozano, 2020. "Expenditure Decentralization: Does It Make Us Happier? An Empirical Analysis Using a Panel of Countries," Sustainability, MDPI, vol. 12(18), pages 1-17, September.
    3. Cinzia Di Novi & Massimiliano Piacenza & Silvana Robone & Gilberto Turati, 2015. "How does fiscal decentralization affect within-regional disparities in well-being? Evidence from health inequalities in Italy," Working Papers 2015:21, Department of Economics, University of Venice "Ca' Foscari".
    4. Jiménez-Rubio, Dolores & García-Gómez, Pilar, 2017. "Decentralization of health care systems and health outcomes: Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 188(C), pages 69-81.
    5. García-Corchero, Juan David & Jiménez-Rubio, Dolores, 2022. "How do policy levers shape the quality of a national health system?," Journal of Policy Modeling, Elsevier, vol. 44(1), pages 203-221.
    6. Ryota Nakatani & Qianqian Zhang & Isaura Garcia Valdes, 2024. "Health Expenditure Decentralization and Health Outcomes: The Importance of Governance," Publius: The Journal of Federalism, CSF Associates Inc., vol. 54(1), pages 59-87.
    7. Mauro, Marianna & Maresso, Anna & Guglielmo, Annamaria, 2017. "Health decentralization at a dead-end: towards new recovery plans for Italian hospitals," LSE Research Online Documents on Economics 74066, London School of Economics and Political Science, LSE Library.

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    More about this item

    Keywords

    health care; decentralization; Spain; citizens’ satisfaction;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H11 - Public Economics - - Structure and Scope of Government - - - Structure and Scope of Government
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare

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