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Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?

Author

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  • Joan Costa-Font

    (Department of Social Policy, London School of Economics and Political Science (LSE), UK)

  • Gilberto Turati

    (Department of Economics and Statistics (Dipartimento di Scienze Economico-Sociali e Matematico-Statistiche), University of Torino, Italy)

Abstract

Does regional decentralization threaten the commitment to regional equality in government outcomes? We attempt to shed 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 counterfactual analysis of regional inequality in government output (health expenditure per capita) and outcome (health system satisfaction) during expansion of health care decentralization in both countries. We find no evidence of increase in regional inequalities in outcomes and outputs in the examined period. Inequalities are accounted for by differences in health system design.

Suggested Citation

  • Joan Costa-Font & Gilberto Turati, 2016. "Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?," Working papers 037, Department of Economics and Statistics (Dipartimento di Scienze Economico-Sociali e Matematico-Statistiche), University of Torino.
  • Handle: RePEc:tur:wpapnw:037
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    References listed on IDEAS

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    Cited by:

    1. 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).
    2. 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.
    3. 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).
    4. 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).
    5. Marta Angelici & Paolo Berta & Joan Costa-i-Font & Gilberto Turati, 2021. "Divided We Survive? Multi-Level Governance and Policy Uncertainty during the First Wave of Covid-19," CESifo Working Paper Series 8999, CESifo.

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    More about this item

    Keywords

    Health Care Decentralization; Regional Inequality; Health Care; Oaxaca Decomposition;
    All these keywords.

    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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