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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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    1. Ankit Kumar & Grégoire de Lagasnerie & Frederica Maiorano & Alessia Forti, 2014. "Pricing and competition in Specialist Medical Services: An Overview for South Africa," OECD Health Working Papers 70, OECD Publishing.
    2. Daron Acemoglu & Amy Finkelstein & Matthew J. Notowidigdo, 2013. "Income and Health Spending: Evidence from Oil Price Shocks," The Review of Economics and Statistics, MIT Press, vol. 95(4), pages 1079-1095, October.
    3. Zeynep Or, 2001. "Exploring the Effects of Health Care on Mortality Across OECD Countries," OECD Labour Market and Social Policy Occasional Papers 46, OECD Publishing.
    4. Anila Channa & Jean-Paul Faguet, 2016. "Decentralization of Health and Education in Developing Countries: A Quality-Adjusted Review of the Empirical Literature," The World Bank Research Observer, World Bank, vol. 31(2), pages 199-241.
    5. Rodrigo Moreno-Serra, 2014. "The impact of cost-containment policies on health expenditure: Evidence from recent OECD experiences," OECD Journal on Budgeting, OECD Publishing, vol. 13(3), pages 1-29.
    6. Chris James & Ivor Beazley & Caroline Penn & Leah Philips & Sean Dougherty, 2019. "Decentralisation in the health sector and responsibilities across levels of government: Impact on spending decisions and the budget," OECD Journal on Budgeting, OECD Publishing, vol. 19(3).
    7. Vasanthakumar Bhat, 2005. "Institutional arrangements and efficiency of health care delivery systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(3), pages 215-222, September.
    8. Milstein, Ricarda & Schreyoegg, Jonas, 2016. "Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries," Health Policy, Elsevier, vol. 120(10), pages 1125-1140.
    9. Rodden, Jonathan, 2003. "Reviving Leviathan: Fiscal Federalism and the Growth of Government," International Organization, Cambridge University Press, vol. 57(4), pages 695-729, October.
    10. Or, Zeynep & Wang, Jia & Jamison, Dean, 2005. "International differences in the impact of doctors on health: a multilevel analysis of OECD countries," Journal of Health Economics, Elsevier, vol. 24(3), pages 531-560, May.
    11. Luca Lorenzoni & Fabrice Murtin & Laura-Sofia Springare & Ane Auraaen & Frederic Daniel, 2018. "Which policies increase value for money in health care?," OECD Health Working Papers 104, OECD Publishing.
    12. Chris James & Marion Devaux & Franco Sassi, 2017. "Inclusive growth and health," OECD Health Working Papers 103, OECD Publishing.
    13. Gerdtham, Ulf-G. & Jonsson, Bengt, 2000. "International comparisons of health expenditure: Theory, data and econometric analysis," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 1, pages 11-53, Elsevier.
    14. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    15. Blomqvist, Ake, 1991. "The doctor as double agent: Information asymmetry, health insurance, and medical care," Journal of Health Economics, Elsevier, vol. 10(4), pages 411-432.
    16. Wallace E. Oates & Wallace E. Oates, 2004. "An Essay on Fiscal Federalism," Chapters, in: Environmental Policy and Fiscal Federalism, chapter 22, pages 384-414, Edward Elgar Publishing.
    17. Elizabeth Docteur & Howard Oxley, 2003. "Health-Care Systems: Lessons from the Reform Experience," OECD Health Working Papers 9, OECD Publishing.
    18. Randall P. Ellis & Thomas G. McGuire, 1993. "Supply-Side and Demand-Side Cost Sharing in Health Care," Journal of Economic Perspectives, American Economic Association, vol. 7(4), pages 135-151, Fall.
    19. Barber, Sarah L. & Kumar, Ankit & Roubal, Tomas & Colombo, Francesca & Lorenzoni, Luca, 2018. "Harnessing the private health sector by using prices as a policy instrument: Lessons learned from South Africa," Health Policy, Elsevier, vol. 122(5), pages 558-564.
    20. Amitabh Chandra & Jonathan S. Skinner, 2011. "Technology Growth and Expenditure Growth in Health Care," NBER Working Papers 16953, National Bureau of Economic Research, Inc.
    21. Rodrigo Moreno-Serra & Peter C. Smith, 2015. "Broader health coverage is good for the nation's health: evidence from country level panel data," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 178(1), pages 101-124, January.
    22. Valérie Paris & Marion Devaux & Lihan Wei, 2010. "Health Systems Institutional Characteristics: A Survey of 29 OECD Countries," OECD Health Working Papers 50, OECD Publishing.
    23. Devlin, Rose Anne & Sarma, Sisira, 2008. "Do physician remuneration schemes matter? The case of Canadian family physicians," Journal of Health Economics, Elsevier, vol. 27(5), pages 1168-1181, September.
    24. Ane Auraaen & Rie Fujisawa & Grégoire de Lagasnerie & Valérie Paris, 2016. "How OECD health systems define the range of good and services to be financed collectively," OECD Health Working Papers 90, OECD Publishing.
    25. Weingast, Barry R., 2009. "Second generation fiscal federalism: The implications of fiscal incentives," Journal of Urban Economics, Elsevier, vol. 65(3), pages 279-293, May.
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    2. 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.
    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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