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Regional healthcare decentralization in unitary states: equal spending, equal satisfaction?

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  • Joan Costa-Font
  • Gilberto Turati

Abstract

Does regional decentralization threaten the commitment to regional equality in government outcomes and outputs? We attempt to shed a light on this question by drawing on unique evidence from the largest European unitary states to have engaged in countrywide health system decentralization: Italy and Spain. We estimate, decompose and run a counterfactual analysis of regional inequality in government output (health expenditure per capita) and outcome (health system satisfaction) during the expansion of healthcare decentralization in both countries. We find no evidence of an increase in regional inequalities in outcomes and outputs in the examined period. Inequalities are accounted for by differences in health system design and management by regional governments.

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  • 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.
    • Handle: RePEc:taf:regstd:v:52:y:2018:i:7:p:974-985
    DOI: 10.1080/00343404.2017.1361527
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    1. Angelici, M. & Berta, P. & Costa-Font, J & Turati, G., 2021. "Divided We Survive? Multi-level Governance and policy uncertainty during the first wave of COVID-19," Health, Econometrics and Data Group (HEDG) Working Papers 21/19, HEDG, c/o Department of Economics, University of York.
    2. 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.
    3. Pasquale Foresti & Oreste Napolitano, 2016. "On the Stock Markets’ Reactions to Taxation and Public Expenditure," LEQS – LSE 'Europe in Question' Discussion Paper Series 115, European Institute, LSE.
    4. Campos, Nauro F. & Macchiarelli, Corrado, 2016. "Core and Periphery in the European Monetary Union: Bayoumi and Eichengreen 25 years later," Economics Letters, Elsevier, vol. 147(C), pages 127-130.
    5. 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).
    6. 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.
    7. Boffardi, Raffaele, 2022. "How efficient is the Italian health system? Evidence on the role of political-institutional dynamics," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    8. Rafaela Oliveira & Gonçalo Santinha & Teresa Sá Marques, 2023. "The Impacts of Health Decentralization on Equity, Efficiency, and Effectiveness: A Scoping Review," Sustainability, MDPI, vol. 16(1), pages 1-32, December.
    9. Costa-Font, Joan & Ferrer-i-Carbonell, Ada, 2022. "Does devolution influence the choice and quality of public (vs private) health care?," Journal of Economic Behavior & Organization, Elsevier, vol. 202(C), pages 632-653.
    10. Andrea Barigazzi & Giovanni Gallo, 2023. "How Pandemic Shock Affects Claim for Minimum Income Measures," Center for the Analysis of Public Policies (CAPP) 0185, Universita di Modena e Reggio Emilia, Dipartimento di Economia "Marco Biagi".
    11. Cristina Borra & Jerònia Pons-Pons & Margarita Vilar-Rodríguez, 2020. "Austerity, healthcare provision, and health outcomes in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 409-423, April.
    12. Vidoli, Francesco & Auteri, Monica, 2022. "Health-care demand and supply at municipal level: A spatial disaggregation approach," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    13. 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).
    14. Balia, Silvia & Brau, Rinaldo & Moro, Daniela, 2020. "Choice of hospital and long-distances: Evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 81(C).
    15. Joan Costa-Font & Ada Ferrer-i-Carbonell, 2019. "Regional Decentralisation and the Demand for Public Health Care," Studies on the Spanish Economy eee2019-41, FEDEA.
    16. Ivana Dobrotic & Teo Matkovic, 2023. "Understanding territorial inequalities in decentralised welfare systems: early childhood education and care system expansion in Croatia," Public Sector Economics, Institute of Public Finance, vol. 47(1), pages 89-110.

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    JEL classification:

    • H7 - Public Economics - - State and Local Government; Intergovernmental Relations
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I3 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty

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