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Convergence, decentralization and spatial effects: An analysis of Italian regional health outcomes

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  • Cavalieri, Marina
  • Ferrante, Livio

Abstract

Fiscal decentralization has been a key component of many health sector reforms. Nevertheless, the actual effects of greater financial accountability by regional governments on reducing geographical health disparities are still debatable. The existing empirical literature is highly fragmented, focusing either on the effect of fiscal decentralization on health outcomes (without considering convergence) or on the convergence process in health (without considering decentralization). This paper aims to make a step forward by disentangling the role played by fiscal decentralization on the convergence dynamics of infant mortality rate and life expectancy at birth, considering also spatial effects. To this purpose, a panel of 20 Italian regions over the period 1996–2016 is investigated. For both our health outcomes, the results point towards no reduction in dispersion levels but evidence of a “catching-up” effect among regions. Exploiting the panel dimension of the data, fiscal decentralization seems to favour the rate of convergence of the Italian regions. However, the fiscal decentralization-growth rate relationship is sensitive to the regional level of health outcome: once high performance levels are reached, more consistent improvements require giving up a certain degree of fiscal accountability. Finally, spatial interactions appear statistically relevant for explaining the regional convergence process.

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  • Cavalieri, Marina & Ferrante, Livio, 2020. "Convergence, decentralization and spatial effects: An analysis of Italian regional health outcomes," Health Policy, Elsevier, vol. 124(2), pages 164-173.
    • Handle: RePEc:eee:hepoli:v:124:y:2020:i:2:p:164-173
    DOI: 10.1016/j.healthpol.2019.12.001
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    as
    1. Hansen, Lars Peter, 1982. "Large Sample Properties of Generalized Method of Moments Estimators," Econometrica, Econometric Society, vol. 50(4), pages 1029-1054, July.
    2. Ryan D. Edwards, 2011. "Changes in World Inequality in Length of Life: 1970–2000," Population and Development Review, The Population Council, Inc., vol. 37(3), pages 499-528, September.
    3. Stephen Bond & Anke Hoeffler & Jonathan Temple, 2001. "GMM Estimation of Empirical Growth Models," Economics Papers 2001-W21, Economics Group, Nuffield College, University of Oxford.
    4. Gary S. Becker & Tomas J. Philipson & Rodrigo R. Soares, 2005. "The Quantity and Quality of Life and the Evolution of World Inequality," American Economic Review, American Economic Association, vol. 95(1), pages 277-291, March.
    5. 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.
    6. Arellano, Manuel & Bover, Olympia, 1995. "Another look at the instrumental variable estimation of error-components models," Journal of Econometrics, Elsevier, vol. 68(1), pages 29-51, July.
    7. David Roodman, 2009. "How to do xtabond2: An introduction to difference and system GMM in Stata," Stata Journal, StataCorp LP, vol. 9(1), pages 86-136, March.
    8. Sala-i-Martin, Xavier X, 1996. "The Classical Approach to Convergence Analysis," Economic Journal, Royal Economic Society, vol. 106(437), pages 1019-1036, July.
    9. Barro, Robert J & Sala-i-Martin, Xavier, 1992. "Convergence," Journal of Political Economy, University of Chicago Press, vol. 100(2), pages 223-251, April.
      • Barro, R.J. & Sala-I-Martin, X., 1991. "Convergence," Papers 645, Yale - Economic Growth Center.
      • Barro, Robert J. & Sala-i-Martin, Xavier, 1992. "Convergence," Scholarly Articles 3451299, Harvard University Department of Economics.
    10. Anila Channa & Jean-Paul Faguet, 2016. "Decentralization of Health and Education in Developing Countries: A Quality-Adjusted Review of the Empirical Literature," The World Bank Research Observer, World Bank, vol. 31(2), pages 199-241.
    11. Hippolyte d'Albis & Loesse Jacques Esso & Héctor Pifarré I Arolas, 2012. "Mortality Convergence Across High-Income Countries : An Econometric Approach," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-00755682, HAL.
    12. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    13. Francesco Porcelli, 2014. "Electoral accountability and local government efficiency: quasi-experimental evidence from the Italian health care sector reforms," Economics of Governance, Springer, vol. 15(3), pages 221-251, August.
    14. Blundell, Richard & Bond, Stephen, 1998. "Initial conditions and moment restrictions in dynamic panel data models," Journal of Econometrics, Elsevier, vol. 87(1), pages 115-143, August.
    15. Robert J. Barro & Xavier Sala-i-Martin, 1991. "Convergence across States and Regions," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 22(1), pages 107-182.
    16. Andrew T. Young & Matthew J. Higgins & Daniel Levy, 2008. "Sigma Convergence versus Beta Convergence: Evidence from U.S. County‐Level Data," Journal of Money, Credit and Banking, Blackwell Publishing, vol. 40(5), pages 1083-1093, August.
    17. 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.
    18. Ryan D. Edwards & Shripad Tuljapurkar, 2005. "Inequality in Life Spans and a New Perspective on Mortality Convergence Across Industrialized Countries," Population and Development Review, The Population Council, Inc., vol. 31(4), pages 645-674, December.
    19. Sen, Amartya, 1998. "Mortality as an Indicator of Economic Success and Failure," Economic Journal, Royal Economic Society, vol. 108(446), pages 1-25, January.
    20. Baltagi, Badi H., 2015. "The Oxford Handbook of Panel Data," OUP Catalogue, Oxford University Press, number 9780199940042, Decembrie.
    21. Stephen Bond & Anke Hoeffler, 2001. "GMM Estimation of Empirical Growth Models," Economics Series Working Papers 2001-W21, University of Oxford, Department of Economics.
    22. Fanny Janssen & Anthe van den Hende & Joop de Beer & Leo van Wissen, 2016. "Sigma and beta convergence in regional mortality: A case study of the Netherlands," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 35(4), pages 81-116.
    23. Martin Gächter & Engelbert Theurl, 2010. "Health Status Convergence at the Local Level: Empirical Evidence from Austria," Working Papers 2010-23, Faculty of Economics and Statistics, Universität Innsbruck, revised Mar 2011.
    24. Antonella Ferrara & Rosanna Nisticò, 2015. "Regional well-being indicators and dispersion from a multidimensional perspective: evidence from Italy," The Annals of Regional Science, Springer;Western Regional Science Association, vol. 55(2), pages 373-420, December.
    25. Laia Maynou & Marc Saez & Jordi Bacaria & Guillem Lopez-Casasnovas, 2015. "Health inequalities in the European Union: an empirical analysis of the dynamics of regional differences," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 543-559, June.
    26. Sergio Rey & Brett Montouri, 1999. "US Regional Income Convergence: A Spatial Econometric Perspective," Regional Studies, Taylor & Francis Journals, vol. 33(2), pages 143-156.
    27. Paolo Mancuso & Vivian Grace Valdmanis, 2016. "Care Appropriateness and Health Productivity Evolution: A Non-Parametric Analysis of the Italian Regional Health Systems," Applied Health Economics and Health Policy, Springer, vol. 14(5), pages 595-607, October.
    28. Chris Wilson, 2001. "On the Scale of Global Demographic Convergence 1950–2000," Population and Development Review, The Population Council, Inc., vol. 27(1), pages 155-171, March.
    29. Quah, D., 1990. "Galton'S Fallacy And The Tests Of The Convergence Hypothesis," Working papers 552, Massachusetts Institute of Technology (MIT), Department of Economics.
    30. Wallace E. Oates & Wallace E. Oates, 2004. "An Essay on Fiscal Federalism," Chapters, in: Environmental Policy and Fiscal Federalism, chapter 22, pages 384-414, Edward Elgar Publishing.
    31. 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.
    32. Clark, Rob, 2011. "World health inequality: Convergence, divergence, and development," Social Science & Medicine, Elsevier, vol. 72(4), pages 617-624, February.
    33. Paolo Berta & Gianmaria Martini & Francesco Moscone & Giorgio Vittadini, 2016. "The association between asymmetric information, hospital competition and quality of healthcare: evidence from Italy," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 179(4), pages 907-926, October.
    34. Grisorio, Maria Jennifer & Prota, Francesco, 2015. "The short and the long run relationship between fiscal decentralization and public expenditure composition in Italy," Economics Letters, Elsevier, vol. 130(C), pages 113-116.
    35. Maria Jennifer Grisorio & Francesco Prota, 2015. "The Impact of Fiscal Decentralization on the Composition of Public Expenditure: Panel Data Evidence from Italy," Regional Studies, Taylor & Francis Journals, vol. 49(12), pages 1941-1956, December.
    36. Andy Pike & Andrés Rodríguez-Pose & John Tomaney & Gianpiero Torrisi & Vassilis Tselios, 2012. "In Search of the ‘Economic Dividend’ of Devolution: Spatial Disparities, Spatial Economic Policy, and Decentralisation in the UK," Environment and Planning C, , vol. 30(1), pages 10-28, February.
    37. Montero-Granados, Roberto & de Dios Jiménez, Juan & Martín, José, 2007. "Decentralisation and convergence in health among the provinces of Spain (1980-2001)," Social Science & Medicine, Elsevier, vol. 64(6), pages 1253-1264, March.
    38. Baumol, William J, 1986. "Productivity Growth, Convergence, and Welfare: What the Long-run Data Show," American Economic Review, American Economic Association, vol. 76(5), pages 1072-1085, December.
    39. Jiménez-Rubio, Dolores, 2011. "The impact of fiscal decentralization on infant mortality rates: Evidence from OECD countries," Social Science & Medicine, Elsevier, vol. 73(9), pages 1401-1407.
    40. Manuel Arellano & Stephen Bond, 1991. "Some Tests of Specification for Panel Data: Monte Carlo Evidence and an Application to Employment Equations," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 58(2), pages 277-297.
    41. Rita De Siano & Marcella D’Uva, 2017. "Fiscal decentralization and spillover effects of local government public spending: the case of Italy," Regional Studies, Taylor & Francis Journals, vol. 51(10), pages 1507-1517, October.
    42. Windmeijer, Frank, 2005. "A finite sample correction for the variance of linear efficient two-step GMM estimators," Journal of Econometrics, Elsevier, vol. 126(1), pages 25-51, May.
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    More about this item

    Keywords

    Italy; Health outcomes; Convergence; Fiscal decentralization; Spatial effects;
    All these keywords.

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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