Fiscal decentralisation and infant mortality rate: The Colombian case
There is a paucity of research analysing the influence of fiscal decentralisation on health outcomes. Colombia is an interesting case study, as health expenditure there has been decentralising since 1993, leading to an improvement in health care insurance. However, it is unclear whether fiscal decentralisation has improved population health. We assess the effect of fiscal decentralisation of health expenditure on infant mortality rates in Colombia. Infant mortality rates for 1080 municipalities over a 10-year period (1998–2007) were related to fiscal decentralisation by using an unbalanced fixed-effect regression model with robust errors. Fiscal decentralisation was measured as the locally controlled health expenditure as a proportion of total health expenditure. We also evaluated the effect of transfers from central government and municipal institutional capacity. In addition, we compared the effect of fiscal decentralisation at different levels of municipal poverty. Fiscal decentralisation decreased infant mortality rates (the elasticity was equal to −0.06). However, this effect was stronger in non-poor municipalities (−0.12) than poor ones (−0.081). We conclude that decentralising the fiscal allocation of responsibilities to municipalities decreased infant mortality rates. However, this improved health outcome effect depended greatly on the socio-economic conditions of the localities. The policy instrument used by the Health Minister to evaluate municipal institutional capacity in the health sector needs to be revised.
Volume (Year): 74 (2012)
Issue (Month): 9 ()
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- Jaime Bonet, 2006. "Fiscal decentralization and regional income disparities: evidence from the Colombian experience," The Annals of Regional Science, Springer;Western Regional Science Association, vol. 40(3), pages 661-676, August.
- AfDB AfDB, . "AfDB Group Annual Report in Brief 2009," Annual Report, African Development Bank, number 65 edited by Koua Louis Kouakou.
- Johannes P. Jütting & Céline Kauffmann & Ida McDonnell & Holger Osterrieder & Nicolas Pinaud & Lucia Wegner, 2004. "Decentralisation and Poverty in Developing Countries: Exploring the Impact," OECD Development Centre Working Papers 236, OECD Publishing.
- Enikolopov, Ruben & Zhuravskaya, Ekaterina, 2007.
"Decentralization and political institutions,"
Journal of Public Economics,
Elsevier, vol. 91(11-12), pages 2261-2290, December.
- Enikolopov, Ruben & Zhuravskaya, Ekaterina, 2003. "Decentralization and Political Institutions," CEPR Discussion Papers 3857, C.E.P.R. Discussion Papers.
- Ruben Enikolopov & Ekaterina Zhuravskaya, 2004. "Decentralization and Political Institutions," Economics Working Papers 0045, Institute for Advanced Study, School of Social Science.
- Ruben Enikolopov & Ekaterina Zhuravskaya, 2006. "Decentralization and Political Institutions," Working Papers w0065, Center for Economic and Financial Research (CEFIR).
- D. Cantarero & Marta Pascual, 2007. "Analysing the impact of fiscal decentralization on health outcomes: empirical evidence from Spain," Applied Economics Letters, Taylor & Francis Journals, vol. 15(2), pages 109-111.
- AfDB AfDB, . "AfDB Group Annual Report 2009," Annual Report, African Development Bank, number 66 edited by Koua Louis Kouakou.
- Boadway,Robin & Shah,Anwar, 2009. "Fiscal Federalism," Cambridge Books, Cambridge University Press, number 9780521732116, March.
- Boadway,Robin & Shah,Anwar, 2009. "Fiscal Federalism," Cambridge Books, Cambridge University Press, number 9780521518215, December.
- Joan Costa-Font & Jordi Pons-Novell, 2007. "Public health expenditure and spatial interactions in a decentralized national health system," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 291-306.
- Joan Costa Font & Jordi Pons Novell, 2005. "Public Health Expenditure and Spatial Interactions in a Decentralized National Health System," Working Papers in Economics 139, Universitat de Barcelona. Espai de Recerca en Economia.
- AfDB AfDB, . "AfDB Group Annual Report 2009 (Portuguese)," Annual Report, African Development Bank, number 67 edited by Koua Louis Kouakou.
- Omar Azfar & Tugrul Gurgur, 2008. "Does corruption affect health outcomes in the Philippines?," Economics of Governance, Springer, vol. 9(3), pages 197-244, July.
- Faguet, Jean-Paul, 2004. "Does decentralization increase government responsiveness to local needs?: Evidence from Bolivia," Journal of Public Economics, Elsevier, vol. 88(3-4), pages 867-893, March.
- AfDB AfDB, . "AfDB Group Annual Report 2009 (Arabic)," Annual Report, African Development Bank, number 68 edited by Koua Louis Kouakou.
- Nadir Habibi & Cindy Huang & Diego Miranda & Victoria Murillo & Gustav Ranis & Mainak Sarkar & Frances Stewart, 2003. "Decentralization and Human Development in Argentina," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 4(1), pages 73-101.
- Robalino, David A. & Picazo, Oscar F. & Voetberg, Albertus, 2001. "Does fiscal decentralization improve health outcomes? - evidence from a cross-country analysis," Policy Research Working Paper Series 2565, The World Bank.
- 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.
- Meloche, Jean-Philippe & Vaillancourt, Francois & Yilmaz, Serdar, 2004. "Decentralization or fiscal autonomy ? What does really matter ? effects on growth and public sector size in European transition countries," Policy Research Working Paper Series 3254, The World Bank.
- Bossert, Thomas John & Mitchell, Andrew David, 2011. "Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan," Social Science & Medicine, Elsevier, vol. 72(1), pages 39-48, January.
- International Monetary Fund, 2001. "Fiscal Decentralization and Governance; A Cross-Country Analysis," IMF Working Papers 01/71, International Monetary Fund. Full references (including those not matched with items on IDEAS)