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Vertical Competition in the Spanish National Health System (NHS)

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  • Joan Costa-Font

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  • Ana Rico

Abstract

In unitary states, competitive decentralisation structures can take place by increasing the visibility of politically accountable jurisdictions in certain policy responsibilities such as health care. Drawing from the Spanish decentralisation process we examine the mechanisms (and determinants) of vertical competition in the development of health policies in the Spanish National Health System. The Spanish example provides qualitative evidence of vertical competition that assimilates government outcomes of unitary states to that of federal structures. The Spanish experience indicates that the specific vertical competition mechanisms in place until 2002 are likely to be responsible for significant policy innovation and welfare state development. Copyright Springer Science+Business Media, Inc. 2006

Suggested Citation

  • Joan Costa-Font & Ana Rico, 2006. "Vertical Competition in the Spanish National Health System (NHS)," Public Choice, Springer, vol. 128(3), pages 477-498, September.
  • Handle: RePEc:kap:pubcho:v:128:y:2006:i:3:p:477-498
    DOI: 10.1007/s11127-005-9011-y
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    References listed on IDEAS

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    1. Guillem López & Joan Costa-Font & Ivan Planas, 2004. "Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'," Economics Working Papers 745, Department of Economics and Business, Universitat Pompeu Fabra.
    2. Breton, Albert & Fraschini, Angela, 2003. "Vertical Competition in Unitary States: The Case of Italy," Public Choice, Springer, vol. 114(1-2), pages 57-77, January.
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    8. Breton,Albert, 1996. "Competitive Governments," Cambridge Books, Cambridge University Press, number 9780521481021, May.
    9. Costa-I-Font, Joan & Rodriguez-Oreggia, Eduardo & Lunapla, Dario, 2003. "Political Competition and Pork-Barrel Politics in the Allocation of Public Investment in Mexico," Public Choice, Springer, vol. 116(1-2), pages 185-204, July.
    10. SALMON, Pierre, 1999. "Vertical competition in a unitary state," LATEC - Document de travail - Economie (1991-2003) 1999-11, LATEC, Laboratoire d'Analyse et des Techniques EConomiques, CNRS UMR 5118, Université de Bourgogne.
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    Cited by:

    1. Joan Costa-Font & Ana Rico, 2006. "Devolution and the Interregional Inequalities in Health and Healthcare in Spain," Regional Studies, Taylor & Francis Journals, vol. 40(8), pages 875-887.
    2. Costa-Font, Joan & Tremosa-Balcells, Ramon, 2008. "Support for state opting out and stateless national identity in the Basque Country," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 37(6), pages 2464-2477, December.
    3. 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.
    4. Joan Costa-Font & Francesco Moscone, 2008. "The impact of decentralization and inter-territorial interactions on Spanish health expenditure," Empirical Economics, Springer, vol. 34(1), pages 167-184, February.

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