Fiscal decentralization in the Italian NHS: What happens to interregional redistribution?
This paper explores how pressures for an increased decentralization of taxing powers to sub-national governments may affect the degree of income redistribution across regional territories accomplished by the Italian NHS. In Italy, political responsibilities for health care are decentralized to regional governments, but the central government retains a critical role in ensuring all citizens uniform access to health services. To this end the central government runs an expenditure needs equalizing system to top up regional governments own resources. However, this system is currently put under question by strong political pressures calling for a weakening of central government involvement. Applying a well developed econometric approach we find that the NHS currently reduces interregional differences in per-capita income by about 7% of GDP. A reform of the NHS in terms of a reduction of expenditure standards produces a weakening of redistribution across jurisdictions, the size of which crucially depends on the financing arrangements of health care that will be actually adopted. We conclude that the decentralization of the NHS would give rise to relevant policy issues concerning in particular the different health care spending possibilities across regions and the impact on the interregional mobility of patients.
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- Xavier Calsamiglia & Teresa Garcia-Milà & Therese J. McGuire, 2004.
"Why do Differences in the Degree of Fiscal Decentralization Endure?,"
193, Barcelona Graduate School of Economics.
- Xavier Calsamiglia & Teresa Garcia-Milà & Therese J. McGuire, 2006. "Why do Differences in the Degree of Fiscal Decentralization Endure?," CESifo Working Paper Series 1877, CESifo Group Munich.
- Xavier Calsamiglia & Teresa Garcia-Milà & Therese J. McGuire, 2004. "Why do differences in the degree of fiscal decentralization endure?," Economics Working Papers 865, Department of Economics and Business, Universitat Pompeu Fabra.
- Cappellaro, Giulia & Fattore, Giovanni & Torbica, Aleksandra, 2009. "Funding health technologies in decentralized systems: A comparison between Italy and Spain," Health Policy, Elsevier, vol. 92(2-3), pages 313-321, October.
- Gaimpaolo Arachi & Alberto Zanardi, 2004. "Designing Intergovernmental Fiscal Relations: Some Insights from the Recent Italian Reform," Fiscal Studies, Institute for Fiscal Studies, vol. 25(3), pages 325-365, September.
- Hodrick, Robert J & Prescott, Edward C, 1997. "Postwar U.S. Business Cycles: An Empirical Investigation," Journal of Money, Credit and Banking, Blackwell Publishing, vol. 29(1), pages 1-16, February.
- Robert J. Hodrick & Edward Prescott, 1981. "Post-War U.S. Business Cycles: An Empirical Investigation," Discussion Papers 451, Northwestern University, Center for Mathematical Studies in Economics and Management Science.
- Patrick Bolton & Gérard Roland, 1997. "The Breakup of Nations: A Political Economy Analysis," The Quarterly Journal of Economics, Oxford University Press, vol. 112(4), pages 1057-1090.
- Haimanko, Ori & Le Breton, Michel & Weber, Shlomo, 2005. "Transfers in a polarized country: bridging the gap between efficiency and stability," Journal of Public Economics, Elsevier, vol. 89(7), pages 1277-1303, July.
- HAIMANKO, Ori & E BRETON, Michel & WEBER, Shlomo, "undated". "Transfers in a polarized country: bridging the gap between efficiency and stability," CORE Discussion Papers RP 1774, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
- Haimanko, Ori & Le Breton, Michel & Weber, Shlomo, 2003. "Transfers in a Polarized Country : Bridging the Gap between Efficiency and Stability," IDEI Working Papers 208, Institut d'Économie Industrielle (IDEI), Toulouse.
- HAIMANKO, Ori & LE BRETON, Michel & WEBER, Shlomo, 2002. "Transfers in a polarized country: bridging the gap between efficiency and stability," CORE Discussion Papers 2002018, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
- Isabelle Joumard & Christophe André & Chantal Nicq, 2010. "Health Care Systems: Efficiency and Institutions," OECD Economics Department Working Papers 769, OECD Publishing.
- Decressin, Jorg, 2002. "Regional income redistribution and risk sharing: how does Italy compare in Europe?," Journal of Public Economics, Elsevier, vol. 86(2), pages 287-306, November.
- Bayoumi, Tamim & Masson, Paul R., 1995. "Fiscal flows in the United States and Canada: Lessons for monetary union in Europe," European Economic Review, Elsevier, vol. 39(2), pages 253-274, February.
- Bayoumi, Tamim & Masson, Paul R, 1994. "Fiscal Flows in the United States and Canada: Lessons for Monetary Union in Europe," CEPR Discussion Papers 1057, C.E.P.R. Discussion Papers.
- Maurice Obstfeld & Giovanni Peri, 1998. "Regional non-adjustment and fiscal policy," Economic Policy, CEPR;CES;MSH, vol. 13(26), pages 205-259, 04.
- Giampaolo Arachi & Caterina Ferrario & Alberto Zanardi, 2010. "Regional Redistribution and Risk Sharing in Italy: The Role of Different Tiers of Government," Regional Studies, Taylor & Francis Journals, vol. 44(1), pages 55-69.
- Alberto ZANARDI & Giampaolo ARACHI & Caterina FERRARIO, "undated". "Regional Redistribution and Risk Sharing in Italy: The Role of Different Tiers of Government," Regional and Urban Modeling 284100049, EcoMod.
- Cavagnero, Eleonora, 2008. "Health sector reforms in Argentina and the performance of the health financing system," Health Policy, Elsevier, vol. 88(1), pages 88-99, October.
- Fabio Padovano, 2007. "The Politics and Economics of Regional Transfers," Books, Edward Elgar Publishing, number 4058, July.
- Bordignon, Massimo & Turati, Gilberto, 2009. "Bailing out expectations and public health expenditure," Journal of Health Economics, Elsevier, vol. 28(2), pages 305-321, March.
- Wallace E. Oates, 1999. "An Essay on Fiscal Federalism," Journal of Economic Literature, American Economic Association, vol. 37(3), pages 1120-1149, September.
- Isabelle Joumard & Per Mathis Kongsrud, 2003. "Fiscal Relations across Government Levels," OECD Economic Studies, OECD Publishing, vol. 2003(1), pages 155-229.
- Isabelle Joumard & Per Mathis Kongsrud, 2003. "Fiscal Relations across Government Levels," OECD Economics Department Working Papers 375, OECD Publishing.
- Paul Bernd Spahn & Jan Werner, 2007. "Germany at the Junction Between Solidarity and Subsidiarity," Chapters,in: Fiscal Fragmentation in Decentralized Countries, chapter 4 Edward Elgar Publishing.
- Benoît Bayenet & Philippe de Bruycker, 2007. "Belgium: A Unique Evolving Federalism," Chapters,in: Fiscal Fragmentation in Decentralized Countries, chapter 6 Edward Elgar Publishing.
- Melitz, Jacques & Zumer, Frederic, 2002. "Regional redistribution and stabilization by the center in Canada, France, the UK and the US:: A reassessment and new tests," Journal of Public Economics, Elsevier, vol. 86(2), pages 263-286, November. Full references (including those not matched with items on IDEAS)