Decentralisation of health care and its impact on health outcomes
AbstractThis paper explores the impact of health care decentralisation on a characteristic of human development: the overall level of a population's health. While much of the literature on decentralisation in health care has stressed the advantages of sub national provision of health services, in the absence of a quantitative measure of the magnitude of the effect of decentralisation, there is little that can be said in terms of its benefits and costs for the health sector. The purpose of this study is therefore to contribute to the limited empirical literature on this issue by investigating the hypothesis that shifts towards more decentralisation would be accompanied by improvements in population health. The analysis draws on a theoretical model of local government's public finance applied to health. We use the ten provinces of Canada as a case study. Apart from being one of the most decentralised countries in the world, Canadian data required to estimate our model was found to be one of the best. The results of the empirical analysis suggest that decentralisation in Canada has had a positive and substantial influence on the effectiveness of public policy in improving population's health.
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Fiscal decentralisation; health outcomes; Canada;
Find related papers by JEL classification:
- I12 - Health, Education, and Welfare - - Health - - - Health Production
- H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism
This paper has been announced in the following NEP Reports:
- NEP-ALL-2005-06-05 (All new papers)
- NEP-HEA-2005-06-05 (Health Economics)
- NEP-PBE-2005-06-05 (Public Economics)
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