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Decentralisation of health care and its impact on health outcomes

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  • Dolores Jimenez
  • Peter C Smith

Abstract

This 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.

Suggested Citation

  • Dolores Jimenez & Peter C Smith, "undated". "Decentralisation of health care and its impact on health outcomes," Discussion Papers 05/10, Department of Economics, University of York.
    • Handle: RePEc:yor:yorken:05/10
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    Cited by:

    1. David Cantarero Prieto & Marta Pascual Saez, "undated". "Decentralisation and health care outcomes: An empirical analysis within the European Union," Studies on the Spanish Economy 220, FEDEA.
    2. Ahmad, Ehtisham & Brosio, Giorgio, 2009. "Decentralization and local service provision: what do we know?," LSE Research Online Documents on Economics 38347, London School of Economics and Political Science, LSE Library.
    3. Castro, Marcelo Araújo & Mattos, Enlinson & Patriota, Fernanda, 2016. "Spatial spillovers and political coordination in public health provision," Textos para discussão 417, FGV EESP - Escola de Economia de São Paulo, Fundação Getulio Vargas (Brazil).
    4. Mr. Ehtisham Ahmad & Mr. Giorgio Brosio & Mr. Vito Tanzi, 2008. "Local Service Provision in Selected OECD Countries: Do Decentralized Operations Work Better?," IMF Working Papers 2008/067, International Monetary Fund.

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    More about this item

    Keywords

    Fiscal decentralisation; health outcomes; Canada;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism

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