Investing in Health Infrastructure: How Decentralization Matters

This paper examines the infrastructure–decentralization nexus in the production of health services with a particular emphasis on the issue of health infrastructure. The first part of the paper presents evidence on health services and infrastructure spending in health for various countries or groups of countries showing the importance of infrastructure spending in the provision of health services. The second part of the paper examines why and how health services are joint production with collective and private characteristics. These characteristics affect the decentralization of such services and thus the decentralization of health infrastructure; it also raises the issue of who should finance what in health care. The third part examines case studies and policy choices in USA, Canada and Switzerland related to various aspects of health care and health infrastructure financing.