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The impact of decentralisation on the performance of health care systems: A non-linear relationship

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  • Sean Dougherty
  • Luca Lorenzoni
  • Alberto Marino
  • Fabrice Murtin

Abstract

This paper examines the relationship between the degree of administrative decentralisation across levels of government in health care decision-making and health care spending, life expectancy as well as hospital costs. This empirical analysis builds on previous analytical research carried out by the OECD (Lorenzoni, Murtin et al., 2018; Lorenzoni and Marino, 2017), both of which established new methodological tools to analyse health sector performance. The present analysis extends this framework to examine the impact of centralisation versus decentralisation of responsibilities across levels of government, making use of newly collected data on governance and expenditure assignment, as well as non-linear empirical specifications.

Suggested Citation

  • Sean Dougherty & Luca Lorenzoni & Alberto Marino & Fabrice Murtin, 2019. "The impact of decentralisation on the performance of health care systems: A non-linear relationship," OECD Working Papers on Fiscal Federalism 27, OECD Publishing.
    • Handle: RePEc:oec:ctpaab:27-en
    DOI: 10.1787/04208b83-en
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    Cited by:

    1. Andrés Rodríguez-Pose & Miquel Vidal-Bover, 2022. "Decentralisation, unfunded mandates, and the regional response to the covid-19 pandemic," Working Papers. Collection A: Public economics, governance and decentralization 2214, Universidade de Vigo, GEN - Governance and Economics research Network.
    2. Wei, Yao & Anselmi, Laura & Munford, Luke & Sutton, Matt, 2023. "The impact of devolution on experienced health and well-being," Social Science & Medicine, Elsevier, vol. 333(C).
    3. Andrea Riganti, 2021. "Containing costs in the Italian local healthcare market," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1001-1014, May.
    4. Guerrero, Omar A. & Castañeda, Gonzalo & Trujillo, Georgina & Hackett, Lucy & Chávez-Juárez, Florian, 2022. "Subnational sustainable development: The role of vertical intergovernmental transfers in reaching multidimensional goals," Socio-Economic Planning Sciences, Elsevier, vol. 83(C).

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    More about this item

    Keywords

    governance; health care; hospitals; intergovernmental relations; Public economics; regional economics;
    All these keywords.

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O43 - Economic Development, Innovation, Technological Change, and Growth - - Economic Growth and Aggregate Productivity - - - Institutions and Growth

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