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Fiscal decentralization in the Italian NHS: What happens to interregional redistribution?

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  • Ferrario, Caterina
  • Zanardi, Alberto

Abstract

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.

Suggested Citation

  • Ferrario, Caterina & Zanardi, Alberto, 2011. "Fiscal decentralization in the Italian NHS: What happens to interregional redistribution?," Health Policy, Elsevier, vol. 100(1), pages 71-80, April.
  • Handle: RePEc:eee:hepoli:v:100:y:2011:i:1:p:71-80
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    References listed on IDEAS

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    Cited by:

    1. Masayoshi Hayashi, 2012. "Channels of Stabilization in a System of Local Public Health Insurance: The Case of the National Health Insurance in Japan," CARF F-Series CARF-F-280, Center for Advanced Research in Finance, Faculty of Economics, The University of Tokyo.
    2. Ferrè, Francesca & Cuccurullo, Corrado & Lega, Federico, 2012. "The challenge and the future of health care turnaround plans: Evidence from the Italian experience," Health Policy, Elsevier, vol. 106(1), pages 3-9.
    3. Raffaele Lagravinese & Paolo Liberati & Giuliano Resce, 2017. "Exploring health outcomes by stochastic multi-objective acceptability analysis: an application to Italian regions," Working Papers. Collection B: Regional and sectoral economics 1703, Universidade de Vigo, GEN - Governance and Economics research Network.
    4. 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".
    5. De Nicola, Arianna & Gitto, Simone & Mancuso, Paolo, 2011. "A two-stage DEA model to evaluate the efficiency of the Italian health system," MPRA Paper 39126, University Library of Munich, Germany.
    6. Masayoshi Hayashi, 2013. "On the Decomposition of Regional Stabilization and Redistribution," CIRJE F-Series CIRJE-F-910, CIRJE, Faculty of Economics, University of Tokyo.
    7. repec:bla:jecsur:v:31:y:2017:i:4:p:1095-1129 is not listed on IDEAS
    8. Jorge Martinez-Vazquez & Santiago Lago-Peñas & Agnese Sacchi, 2017. "The Impact Of Fiscal Decentralization: A Survey," Journal of Economic Surveys, Wiley Blackwell, vol. 31(4), pages 1095-1129, September.
    9. Federico Revelli, 2012. "Business taxation and economic performance in hierarchical government structures," Working Papers 2012/12, Institut d'Economia de Barcelona (IEB).
    10. Rosella Levaggi & Francesco Menoncin, 2015. "Would less solidarity justify present calls for devolution?," Working papers 32, Società Italiana di Economia Pubblica.
    11. José-Ignacio Antón & Rafael Muñoz de Bustillo & Enrique Fernández Macías & Jesús Rivera, 2014. "Effects of health care decentralization in Spain from a citizens’ perspective," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 411-431, May.
    12. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    13. Lagravinese, Raffaele & Paradiso, Massimo, 2012. "Corruption and health expenditure in Italy," MPRA Paper 43215, University Library of Munich, Germany.
    14. Giannola, Adriano & Petraglia, Carmelo & Scalera, Domenico, 2016. "Net fiscal flows and interregional redistribution in Italy: A long-run perspective (1951–2010)," Structural Change and Economic Dynamics, Elsevier, vol. 39(C), pages 1-16.
    15. repec:kap:itaxpf:v:24:y:2017:i:5:d:10.1007_s10797-016-9436-x is not listed on IDEAS
    16. 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.
    17. repec:eee:injoed:v:53:y:2017:i:c:p:12-27 is not listed on IDEAS
    18. de Belvis, Antonio Giulio & Ferrè, Francesca & Specchia, Maria Lucia & Valerio, Luca & Fattore, Giovanni & Ricciardi, Walter, 2012. "The financial crisis in Italy: Implications for the healthcare sector," Health Policy, Elsevier, vol. 106(1), pages 10-16.

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