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Devolution and the Interregional Inequalities in Health and Healthcare in Spain

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  • Joan Costa-Font
  • Ana Rico

Abstract

Costa-Font J. and Rico A. (2006) Devolution and the interregional inequalities in health and healthcare in Spain, Regional Studies 40, 875-887. The desirability of devolution of government responsibilities is often questioned on the grounds of regional cohesion concerns. This feature is especially relevant in welfare policy areas such as healthcare services given their impact on an individual's well-being. This paper examines the effects of health system devolution on the emergence of inter-territorial inequalities in healthcare outcomes (mortality) and outputs (healthcare expenditure) in the Spanish National Health System (NHS). Based on an empirical model for regional health expenditure, and drawing from a battery of inequality indicators (some taken from previous studies, other estimated anew), the following results are obtained. First, healthcare devolution has not led to an expansion of regional inequalities in healthcare outcomes and outputs. Second, there is no clear-cut evidence that devolution increases public health expenditure (in real terms) in devolved region-states, with the exception of fiscally accountable autonomous communities (ACs). Finally, regional health expenditure is explained by differences in need and higher reliance healthcare inputs use, size effects as well as the region-specific economic and demographic dimension in addition to regional income. Costa-Font J. et Rico A. (2006) La regionalisation et les inegalites de sante et des services medicaux en Espagne, Regional Studies 40, 875-887. Souvent on remet en question les avantages de la regionalisation des competences gouvernementales en raison des questions qui se posent quant a la cohesion regionale. Cela est particulierement pertinent dans le domaine des politiques en faveur des services medicaux, etant donne leur impact sur le bien-etre de l'individu. Cet article cherche a examiner les retombees de la regionalisation des services de sante sur la naissance des inegalites des resultats des services medicaux (mortalite) et des rendements (depenses de sante) dans la Securite Sociale espagnole. A partir d'un modele econometrique des depenses de sante, et puisant dans une batterie d'indices d'inegalite (dont certains proviennent des etudes anterieures et dont d'autres sont de nouvelles estimations), on obtient les resultats suivants. Primo, la regionalisation des services medicaux n'a entraine un creusement des inegalites regionales ni des resultats, ni des rendements des services medicaux. Secundo, il reste a prouver que la regionalisation augmente les depenses de sante publique (en termes reels), a l'exception des AC qui sont fiscalement autonomes. Pour conclure, on explique les depenses de sante regionales en termes du besoin et de l'utilisation des facteurs medicaux dont on depend davantage, des effets de taille ainsi que des dimensions economique et demographique specifiques d'une region en plus du revenu regional. Inegalites regionales Interactions politiques Responsabilite politique Secu Costa-Font J. und Rico A. (2006) Dezentralisierung und die von Region zu Region zu beobachtenden Unterschiede der Gesundheit und Gesundheitsfursorge in Spanien, Regional Studies 40, 875-887. Auf Grund der Besorgnis um regionale Kohasion fragt man sich oft, ob die Dezentralisierung der Regierungsverantwortlichkeit wunschenswert ist. In Anbetracht der Auswirkung auf das Wohlergehen individueller Personen betrifft dieser Aspekt besonders Aufgabengebiete derWohlfahrtspolitik, wie z.B. Gesundheitsfursorge. DieserAufsatz untersucht die Wirkung der Dezentralisierung des Gesundheitswesens auf von Region zu Region beobachteten Unterschieden in den Ergebnissen der Gesundheitsfursorge (Sterblichkeit) und Aufwand (Ausgaben fur Gesundheitsfursorge) im Gesundheitswesen des spanischen Staates (NHS). Gestutzt sowohl auf ein empirisches Modell fur regionale Gesundheitsausgaben als auch eine Reihe Unterschiedsindikatoren (manche fruheren Studien entnommen, andere von neueren Berechnungen) werden folgende Ergebnisse erzielt:erstens, dass die Dezentralisierung der Gesundheitsfursorge nicht zu einer Ausweitung regionaler Unterschiede der Ergebnisse der Gesundheitsfursorge gefuhrt hat, und zweitens sich keine eindeutigen Beweise ergaben, dass Dezentralisierung die Ausgaben fur das offentliche Gesundheitswesen mit Ausnahme des finanziell verantwortlichen AC in zentralierten Regionalstaaten (effektiv)gestiegen sind. Abschliessend werden regionale Ausgaben fur das Gesundheitswesen zusatzlich regionler Einkommen durch Unterschiede in Bedarf und grosserem Verlass auf Inanspruchnahme des Gesundheitsfursorgeaufwands, durch Grosseneffekte sowie spezifische wirtschaftliche und demographische Dimensionen erklart. Regionale Unterschiede Politische Wechselwirkungen Politische Verantwortlichkeit NHS Costa-Font J. y Rico A. (2006) Transferencia de competencias y las desigualdades interregionales en la salud y la atencion sanitaria en Espana, Regional Studies 40, 875-887. A menudo se cuestiona la conveniencia de la transferencia de las competencias del gobierno porque se teme que peligre la cohesion regional. Esta cuestion es especialmente relevante en temas de la politica del bienestar tales como los servicios de atencion sanitaria, puesto que tienen mucho impacto en el bienestar del individuo. En este articulo examinamos que efectos ha tenido la transferencia de competencias del sistema de la salud en cuanto a la aparicion de desigualdades interterritoriales en los resultados de la atencion sanitaria (mortalidad) y la inversion (gasto de la atencion sanitaria) en el sistema de la Seguridad Social en Espana. Basandonos en un modelo empirico para el gasto de la salud en las comunidades autonomas y segun una bateria de indicadores de desigualdades (algunos extraidos de estudios previos, y otros de calculos nuevos), obtenemos los siguientes resultados. Primero, la transferencia de la competencia de atencion sanitaria no ha llevado a una expansion de las desigualdades regionales en los resultados y las inversiones. Segundo, no hay pruebas claras de que la transferencia de competencias aumente el gasto de la salud publica (en terminos reales) en los estados regionales con las competencias transferidas con la excepcion de una contabilidad fiscalmente responsable. Para terminar, el gasto de la salud en las comunidades autonomas se explica por las diferencias en las necesidades y una mayor dependencia de la atencion sanitaria, los efectos del tamano asi como la dimension economica y demografica de la region en cuestion, ademas de los ingresos regionales. Desigualdades regionales Interacciones politicas Responsabilidad politica Seguridad Social

Suggested Citation

  • 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.
    • Handle: RePEc:taf:regstd:v:40:y:2006:i:8:p:875-887
    DOI: 10.1080/00343400600984346
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    1. Kevin Morgan, 2001. "The New Territorial Politics: Rivalry and Justice in Post-devolution Britain," Regional Studies, Taylor & Francis Journals, vol. 35(4), pages 343-348.
    2. Federico Revelli, 2002. "Testing the taxmimicking versus expenditure spill-over hypotheses using English data," Applied Economics, Taylor & Francis Journals, vol. 34(14), pages 1723-1731.
    3. Rubinfeld, Daniel L., 1987. "The economics of the local public sector," Handbook of Public Economics, in: A. J. Auerbach & M. Feldstein (ed.), Handbook of Public Economics, edition 1, volume 2, chapter 11, pages 571-645, Elsevier.
    4. Salmon, Pierre, 1987. "Decentralisation as an Incentive Scheme," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 3(2), pages 24-43, Summer.
    5. Charles M. Tiebout, 1956. "A Pure Theory of Local Expenditures," Journal of Political Economy, University of Chicago Press, vol. 64(5), pages 416-416.
    6. Costa-Font, J. & Hernandez-Quevedo, C., 2013. "Inequalities in Self-Reported Health: A Meta-Regression Analysis," Health, Econometrics and Data Group (HEDG) Working Papers 13/05, HEDG, c/o Department of Economics, University of York.
    7. Besley, Timothy & Case, Anne, 1995. "Incumbent Behavior: Vote-Seeking, Tax-Setting, and Yardstick Competition," American Economic Review, American Economic Association, vol. 85(1), pages 25-45, March.
    8. Federico Revelli, 2001. "Spatial patterns in local taxation: tax mimicking or error mimicking?," Applied Economics, Taylor & Francis Journals, vol. 33(9), pages 1101-1107.
    9. 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.
    10. 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.
    11. Joan Costa & Jaume Garcia, 2003. "Demand for private health insurance: how important is the quality gap?," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 587-599, July.
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    1. Joan Costa‐Font & Laurie Perdikis, 2021. "Policy interdependence and the models of health care devolution: “Systems or federacies”?," Regional Science Policy & Practice, Wiley Blackwell, vol. 13(3), pages 492-500, June.
    2. Giardina, Emilio & Cavalieri, Marina & Guccio, Calogero & Mazza, Isidoro, 2009. "Federalism, Party Competition and Budget Outcome: Empirical Findings on Regional Health Expenditure in Italy," MPRA Paper 16437, University Library of Munich, Germany.
    3. Laia Bosque‐Mercader & Neus Carrilero & Anna García‐Altés & Guillem López‐Casasnovas & Luigi Siciliani, 2023. "Socioeconomic inequalities in waiting times for planned and cancer surgery: Evidence from Spain," Health Economics, John Wiley & Sons, Ltd., vol. 32(5), pages 1181-1201, May.
    4. Masayoshi Hayashi, 2011. "The effects of medical factors on transfer deficits in Public Assistance in Japan: a quantile regression analysis," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 287-307, December.
    5. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Economics and Management, Springer, vol. 10(3), pages 219-237, September.
    6. José-Ignacio Antón & Rafael Muñoz de Bustillo & Enrique Fernández Macías & Jesús Rivera, 2014. "Effects of health care decentralization in Spain from a citizens’ perspective," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 411-431, May.
    7. Gökçe MANAVGAT & Ayhan DEMİRCİ, 2020. "Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey," Sosyoekonomi Journal, Sosyoekonomi Society, issue 28(44).
    8. Antonio Jurado & Jesus Perez-Mayo & Francisco Pedraja, 2016. "The Impact of Public Services Expenditure on the Spanish Income Distribution," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 127(1), pages 217-241, May.
    9. Clemente, Jesús & Lazaro, Angelina & Montanes, Antonio, 2016. "Public health expenditure in Spain: is there partisan behaviour?," MPRA Paper 69781, University Library of Munich, Germany.
    10. Marta Angelici & Paolo Berta & Joan Costa-Font & Gilberto Turati, 2023. "Divided We Survive? Multilevel Governance during the COVID-19 Pandemic in Italy and Spain," Publius: The Journal of Federalism, CSF Associates Inc., vol. 53(2), pages 227-250.
    11. 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, March.
    12. Joan Costa-i-Font, 2012. "Fiscal Federalism and European Health System Decentralization: A Perspective," LEQS – LSE 'Europe in Question' Discussion Paper Series 55, European Institute, LSE.
    13. Daniele Mascia & Francesca Pallotti & Federica Angeli, 2017. "Don’t stand so close to me: competitive pressures, proximity and inter-organizational collaboration," Regional Studies, Taylor & Francis Journals, vol. 51(9), pages 1348-1361, September.
    14. Yue Dong & Dipanwita Sarkar & Jayanta Sarkar, 2021. "Decentralization and health resource allocation: Quasi-experimental evidence from China," QuBE Working Papers 060, QUT Business School.
    15. Masayoshi Hayashi & Akiko Oyama, 2014. "Factor Decomposition of Inter-prefectural Health Care Expenditure Disparities in Japan," CIRJE F-Series CIRJE-F-948, CIRJE, Faculty of Economics, University of Tokyo.
    16. Judit Vall Castelló & Joan Costa-Font & Gilberto Turati & Dolores Jiménez-Rubio & Pilar García-Gómez, 2019. "Health Economics: Service Provision in Decentralised Healthcare Systems / Economía de la salud: prestación de servicios en sistemas de salud descentralizados / Economia de la salut: prestació de serve," IEB Reports ieb_report_1_2019, Institut d'Economia de Barcelona (IEB).
    17. Joan Costa-Font & Gilberto Turati, 2018. "Regional healthcare decentralization in unitary states: equal spending, equal satisfaction?," Regional Studies, Taylor & Francis Journals, vol. 52(7), pages 974-985, July.
    18. Bertoli, Paola & Grembi, Veronica & Llaneza Hesse, Catalina & Vall Castelló, Judit, 2020. "The effect of budget cuts on C-section rates and birth outcomes: Evidence from Spain," Social Science & Medicine, Elsevier, vol. 265(C).
    19. Bech, Mickael & Lauridsen, Jørgen, 2008. "Exploring the spatial pattern in hospital admissions," Health Policy, Elsevier, vol. 87(1), pages 50-62, July.
    20. Clemente, Jesús & Lázaro-Alquézar, Angelina & Montañés, Antonio, 2019. "Convergence in Spanish Public health expenditure: Has the decentralization process generated disparities?," Health Policy, Elsevier, vol. 123(5), pages 503-507.
    21. Alessandra Cepparulo & Luisa Giuriato, 2022. "The residential healthcare for the elderly in Italy: some considerations for post-COVID-19 policies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(4), pages 671-685, June.
    22. Torrini, Irene & Grassetti, Luca & Rizzi, Laura, 2023. "Under-spending, over-spending or substitution among services? Spatial patterns of unexplained shares of health care expenditures," Health Policy, Elsevier, vol. 137(C).
    23. Costa-Font, Joan & Perdikis, Laurie, 2019. "Policy interdependence and the models of health care devolution: “systems or federacies”?," LSE Research Online Documents on Economics 102200, London School of Economics and Political Science, LSE Library.
    24. Sumah, Anthony Mwinkaara & Baatiema, Leonard & Abimbola, Seye, 2016. "The impacts of decentralisation on health-related equity: A systematic review of the evidence," Health Policy, Elsevier, vol. 120(10), pages 1183-1192.
    25. Joan Costa-Font, 2010. "Does Devolution Lead to Regional Inequalities in Welfare Activity?," Environment and Planning C, , vol. 28(3), pages 435-449, June.

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