IDEAS home Printed from https://ideas.repec.org/a/spr/epolit/v34y2017i3d10.1007_s40888-016-0052-0.html
   My bibliography  Save this article

The distributional impact of health public expenditure in Italian regions: what happens when cost-effectiveness and quality matter?

Author

Listed:
  • Laura Bianchini

    (Department of Transportation)

  • Santino Piazza

    (IRES Piemonte)

  • Alberto Cassone

    (Universita’ del Piemonte Orientale A. Avogadro)

Abstract

We evaluate the implications of in-kind health transfers on household income distribution in Italy, factoring in the quality of government-provided healthcare in different regions (which are responsible for health policy). The novelty of this approach is that we explicitly acknowledge differences in the value of in-kind transfers resulting from cross-regional variations in service quality. The aim of this paper is twofold. First we adopt a fiscal federalism approach to assess the distributional implications of adding health public expenditure to the disposable income of Italian households and we compare the distributional results across regions. We then take a yardstick competition approach to evaluate the distributional implications of accounting for the quality and efficiency of services. To analyze the distributional impact of health public expenditure, we show the difference of the Gini index between final income and disposable income for each region and the progressivity index (Kakwani index). The re-ranking effect and the average in-kind benefit rate (that is the ratio of total in-kind transfers to disposable income) are also computed. Our analysis provides convincing evidence that when health services are evaluated at production cost, in-kind benefits reduce overall inequality on the distribution of disposable income. However, this effect is seen to be lower when the yardstick competition approach is applied to account for quality and cost-effectiveness, and, more importantly, it shows a geographical pattern.

Suggested Citation

  • Laura Bianchini & Santino Piazza & Alberto Cassone, 2017. "The distributional impact of health public expenditure in Italian regions: what happens when cost-effectiveness and quality matter?," Economia Politica: Journal of Analytical and Institutional Economics, Springer;Fondazione Edison, vol. 34(3), pages 445-469, December.
    • Handle: RePEc:spr:epolit:v:34:y:2017:i:3:d:10.1007_s40888-016-0052-0
    DOI: 10.1007/s40888-016-0052-0
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40888-016-0052-0
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s40888-016-0052-0?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    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. Rosella Levaggi & Francesco Menoncin, 2013. "Soft budget constraints in health care: evidence from Italy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(5), pages 725-737, October.
    2. Aaberge, Rolf & Langørgen, Audun & Mogstad, Magne & Østensen, Marit, 2008. "The Impact of Local Public Services and Geographical Cost of Living Differences on Poverty Estimates," IZA Discussion Papers 3686, Institute of Labor Economics (IZA).
    3. Rolf Aaberge & Audun Langørgen, 2006. "Measuring The Benefits From Public Services: The Effects Of Local Government Spending On The Distribution Of Income In Norway," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 52(1), pages 61-83, March.
    4. Timothy Smeeding & Gunther Schmaus & Brigitte Buhmann & Lee Rainwater, 1988. "Equivalence Scales, Well-Being, Inequality and Poverty: Sensitivity Estimates Across Ten Countries Using the LIS Database," LIS Working papers 17, LIS Cross-National Data Center in Luxembourg.
    5. repec:bla:revinw:v:39:y:1993:i:3:p:229-56 is not listed on IDEAS
    6. Gerlinde Verbist & Michael Förster & Maria Vaalavuo, 2012. "The Impact of Publicly Provided Services on the Distribution of Resources: Review of New Results and Methods," OECD Social, Employment and Migration Working Papers 130, OECD Publishing.
    7. Callan, Tim & Keane, Claire, 2009. "Non-cash Benefits and the Distribution of Economic Welfare," The Economic and Social Review, Economic and Social Studies, vol. 40(1), pages 49-71.
    8. Alari Paulus & Holly Sutherland & Panos Tsakloglou, 2010. "The distributional impact of in-kind public benefits in European countries," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 29(2), pages 243-266.
    9. Aaberge, Rolf & Bhuller, Manudeep & Langørgen, Audun & Mogstad, Magne, 2010. "The distributional impact of public services when needs differ," Journal of Public Economics, Elsevier, vol. 94(9-10), pages 549-562, October.
    10. Aleksandra Torbica & Giovanni Fattore, 2005. "The “Essential Levels of Care” in Italy: when being explicit serves the devolution of powers," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(1), pages 46-52, November.
    11. Atkinson, Tony & Cantillon, Bea & Marlier, Eric & Nolan, Brian, 2002. "Social Indicators: The EU and Social Inclusion," OUP Catalogue, Oxford University Press, number 9780199253494.
    12. Aaron, Henry & McGuire, Martin, 1970. "Public Goods and Income Distribution," Econometrica, Econometric Society, vol. 38(6), pages 907-920, November.
    13. Rosella Levaggi & Roberto Zanola, 2004. "Patients' migration across regions: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 36(16), pages 1751-1757.
    14. Massimo Baldini & Daniele Pacifico, 2006. "Gli effetti distributivi dei trasferimenti in kind: il caso dei servizi educativi e sanitari," Center for the Analysis of Public Policies (CAPP) 0018, Universita di Modena e Reggio Emilia, Dipartimento di Economia "Marco Biagi".
    15. Tony Atkinson & Bea Cantillon & Eric Marlier & Brian Nolan, 2002. "Indicators for Social Inclusion," Politica economica, Società editrice il Mulino, issue 1, pages 7-28.
    16. Andrei Shleifer, 1985. "A Theory of Yardstick Competition," RAND Journal of Economics, The RAND Corporation, vol. 16(3), pages 319-327, Autumn.
    17. A.B. Atkinson & F. Bourguignon (ed.), 2000. "Handbook of Income Distribution," Handbook of Income Distribution, Elsevier, edition 1, volume 1, number 1.
    18. Daniel B. Radner, 1997. "Noncash Income, Equivalence Scales, And The Measurement Of Economic Well‐Being," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 43(1), pages 71-88, March.
    19. Brennan, Geoffrey, 1976. "The Distributional Implications of Public Goods," Econometrica, Econometric Society, vol. 44(2), pages 391-399, March.
    20. Daniela Sonedda & Gilberto Turati, 2005. "Winners and Losers in the Italian Welfare State: A Microsimulation Analysis of Income Redistribution Considering In-Kind Transfers," Giornale degli Economisti, GDE (Giornale degli Economisti e Annali di Economia), Bocconi University, vol. 64(4), pages 423-464, December.
    21. Rosella Levaggi & Francesco Menoncin, 2008. "Fiscal Federalism, Patient Mobility and Soft Budget Constraint in Italy," Politica economica, Società editrice il Mulino, issue 3, pages 367-388.
    22. repec:bla:revinw:v:34:y:1988:i:2:p:115-42 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Christos Koutsampelas & Panos Tsakloglou, 2013. "The distribution of full income in Greece," International Journal of Social Economics, Emerald Group Publishing Limited, vol. 40(4), pages 311-330, March.
    2. Rolf Aaberge & Audun Langørgen & Petter Lindgren, 2013. "The distributional impact of public services in," Discussion Papers 746, Statistics Norway, Research Department.
    3. Tess Penne & Irene Cussó Parcerisas & Lauri Mäkinen & Bérénice Storms & Tim Goedemé, 2016. "Can reference budgets be used as a poverty line?," ImPRovE Working Papers 16/05, Herman Deleeck Centre for Social Policy, University of Antwerp.
    4. Verbist, G. (Gerlinde) & Matsaganis, M. (Manos), 2012. "GINI DP 53: The Redistributive Capacity of Services in the EU," GINI Discussion Papers 53, AIAS, Amsterdam Institute for Advanced Labour Studies.
    5. Aaberge, Rolf & Eika, Lasse & Langørgen, Audun & Mogstad, Magne, 2019. "Local governments, in-kind transfers, and economic inequality," Journal of Public Economics, Elsevier, vol. 180(C).
    6. Francesco Figari & Alari Paulus, 2015. "The Distributional Effects of Taxes and Transfers Under Alternative Income Concepts," Public Finance Review, , vol. 43(3), pages 347-372, May.
    7. Hillringhaus, Tilman & Peichl, Andreas, 2010. "Die Messung von Armut unter Berücksichtigung regional divergierender Lebenshaltungskosten und öffentlicher Leistungen," IZA Discussion Papers 5344, Institute of Labor Economics (IZA).
    8. Marx, Ive & Nolan, Brian & Olivera, Javier, 2014. "The Welfare State and Anti-Poverty Policy in Rich Countries," IZA Discussion Papers 8154, Institute of Labor Economics (IZA).
    9. DECANCQ, Koen & FLEURBAEY, Marc & SCHOKKAERT, Erik, 2014. "Inequality, income, and well-being," LIDAM Discussion Papers CORE 2014018, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    10. Gerlinde Verbist & Michael Föster & Vaalavou, M., 2013. "GINI DP 74: The Impact of Publicly Provided Services on the Distribution of Resources: Review of New Results and Methods," GINI Discussion Papers 74, AIAS, Amsterdam Institute for Advanced Labour Studies.
    11. Amedeo Spadaro & Lucia Mangiavacchi & Ignacio Moral-Arce & Marta Adiego-Estella & Angela Blanco-Moreno, 2013. "Evaluating the redistributive impact of public health expenditure using an insurance value approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(5), pages 775-787, October.
    12. Bérénice Storms & Tim Goedemé & Karel Van den Bosch & Kristof Devuyst, 2013. "Towards a common framework for developing cross-nationally comparable reference budgets in Europe," ImPRovE Working Papers 13/02, Herman Deleeck Centre for Social Policy, University of Antwerp.
    13. Markus M. Grabka & Gerlinde Verbist, 2015. "Non-cash benefits from social housing in Europe: a comparative perspective," ImPRovE Working Papers 15/07, Herman Deleeck Centre for Social Policy, University of Antwerp.
    14. Figari, Francesco & Paulus, Alari, 2013. "The distributional effects of taxes and transfers under alternative income concepts: the importance of three ‘I’s," EUROMOD Working Papers EM15/13, EUROMOD at the Institute for Social and Economic Research.
    15. Stefan Kranzinger, 2020. "The decomposition of income inequality in the EU-28," Empirica, Springer;Austrian Institute for Economic Research;Austrian Economic Association, vol. 47(3), pages 643-668, August.
    16. Frick, Joachim R. & Grabka, Markus M. & Smeeding, Timothy M. & Tsakloglou, Panos, 2010. "Distributional Effects of Imputed Rents in Five European Countries," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 19(3), pages 167-179.
    17. Aaberge, Rolf & Bhuller, Manudeep & Langørgen, Audun & Mogstad, Magne, 2010. "The distributional impact of public services when needs differ," Journal of Public Economics, Elsevier, vol. 94(9-10), pages 549-562, October.
    18. Luca Giangregorio, 2024. "Welfare type and income inequality: an income source decomposition including in-kind benefits and cash-transfers entitlement," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 31(2), pages 367-403, April.
    19. Tess Penne & Tine Hufkens & Tim Goedeme & Berenice M L Storms, 2018. "To what extent do welfare states compensate for the cost of children? A hypothetical household approach to policy evaluations," JRC Working Papers on Taxation & Structural Reforms 2018-08, Joint Research Centre.
    20. Salvatore Morelli & Timothy Smeeding & Jeffrey Thompson, 2014. "Post-1970 Trends in Within-Country Inequality and Poverty: Rich and Middle Income Countries," CSEF Working Papers 356, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.

    More about this item

    Keywords

    Health policy; Distributional impact; In-kind transfers; Public expenditure and service quality;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare

    Statistics

    Access and download statistics

    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:spr:epolit:v:34:y:2017:i:3:d:10.1007_s40888-016-0052-0. See general information about how to correct material in RePEc.

    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 bibliographic 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.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

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

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.