IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v75y2012i9p1595-1603.html
   My bibliography  Save this article

Allocation of authority in European health policy

Author

Listed:
  • Adolph, Christopher
  • Greer, Scott L.
  • Massard da Fonseca, Elize

Abstract

Although many study the effects of different allocations of health policy authority, few ask why countries assign responsibility over different policies as they do. We test two broad theories: fiscal federalism, which predicts rational governments will concentrate information-intensive operations at lower levels, and redistributive and regulatory functions at higher levels; and “politicized federalism”, which suggests a combination of systematic and historically idiosyncratic political variables interfere with efficient allocation of authority. Drawing on the WHO Health in Transition country profiles, we present new data on the allocation of responsibility for key health care policy tasks (implementation, provision, finance, regulation, and framework legislation) and policy areas (primary, secondary and tertiary care, public health and pharmaceuticals) in the 27 EU member states and Switzerland. We use a Bayesian multinomial mixed logit model to analyze how different countries arrive at different allocations of authority over each task and area of health policy, and find the allocation of powers broadly follows fiscal federalism. Responsibility for pharmaceuticals, framework legislation, and most finance lodges at the highest levels of government, acute and primary care in the regions, and provision at the local and regional levels. Where allocation does not follow fiscal federalism, it appears to reflect ethnic divisions, the population of states and regions, the presence of mountainous terrain, and the timing of region creation.

Suggested Citation

  • Adolph, Christopher & Greer, Scott L. & Massard da Fonseca, Elize, 2012. "Allocation of authority in European health policy," Social Science & Medicine, Elsevier, vol. 75(9), pages 1595-1603.
  • Handle: RePEc:eee:socmed:v:75:y:2012:i:9:p:1595-1603 DOI: 10.1016/j.socscimed.2012.05.041
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953612005047
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. repec:cup:apsrev:v:97:y:2003:i:01:p:75-90_00 is not listed on IDEAS
    2. Weaver, R. Kent, 1986. "The Politics of Blame Avoidance," Journal of Public Policy, Cambridge University Press, vol. 6(04), pages 371-398, October.
    3. Bednar,Jenna, 2009. "The Robust Federation," Cambridge Books, Cambridge University Press, number 9780521703963, December.
    4. Bednar,Jenna, 2009. "The Robust Federation," Cambridge Books, Cambridge University Press, number 9780521878999, December.
    5. Fredriksson, Mio & Winblad, Ulrika, 2008. "Consequences of a decentralized healthcare governance model: Measuring regional authority support for patient choice in Sweden," Social Science & Medicine, Elsevier, vol. 67(2), pages 271-279, July.
    6. Bossert, Thomas, 1998. "Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance," Social Science & Medicine, Elsevier, vol. 47(10), pages 1513-1527, November.
    7. Wallace E. Oates, 1999. "An Essay on Fiscal Federalism," Journal of Economic Literature, American Economic Association, vol. 37(3), pages 1120-1149, September.
    8. Valérie Paris & Marion Devaux & Lihan Wei, 2010. "Health Systems Institutional Characteristics: A Survey of 29 OECD Countries," OECD Health Working Papers 50, OECD Publishing.
    9. Weingast, Barry R., 2009. "Second generation fiscal federalism: The implications of fiscal incentives," Journal of Urban Economics, Elsevier, vol. 65(3), pages 279-293, May.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Emanuela Marrocu & Silvia Balia & Rinaldo Brau, 2016. "A spatial analysis of inter-regional patient mobility in Italy," ERSA conference papers ersa16p127, European Regional Science Association.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:75:y:2012:i:9:p:1595-1603. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.