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Regional Institutional Quality and Territorial Equity in LTC Provision

Author

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  • Anna Marenzi

    (Department of Economics, Ca' Foscari University of Venice; CRIEP)

  • Dino Rizzi

    (Department of Economics, Ca' Foscari University of Venice; CRIEP)

  • Michele Zanette

    (Department of Economics, Ca' Foscari University of Venice CÃ Foscari; CRIEP)

  • Francesca Zantomio

    (Department of Economics, Ca' Foscari University of Venice; CRIEP; HEDG (York))

Abstract

We show how regional governments affect the appropriate – in terms of territorial equity - assignment of a national LTC benefit. We analyse a three-layers setting, where eligibility criteria are defined by the central government (which bears the fiscal cost of transfers) but the assignment decision is taken by regional medical commissions, while applications are activated by individual potential beneficiaries. Combining administrative and survey data, and accounting for regional variation in eligibility prevalence, we document large territorial disparities in need-adjusted benefit assignment. We investigate the determinants of such disparities both in terms of individuals' differential propensity to claim, and of regional discretionary behaviour, as shaped by the underlying quality of regional institutions. Regional discretion appears to play a major role, with local institutional quality accounting for about one fifth of explained variation in need-adjusted benefit coverage. Lower regional institutional quality results in more opportunistic benefit adjudication decisions, although the relationship is attenuated in highly deprived areas.

Suggested Citation

  • Anna Marenzi & Dino Rizzi & Michele Zanette & Francesca Zantomio, 2022. "Regional Institutional Quality and Territorial Equity in LTC Provision," Working Papers 2022:15, Department of Economics, University of Venice "Ca' Foscari".
  • Handle: RePEc:ven:wpaper:2022:15
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    More about this item

    Keywords

    Territorial equity; regional discretion; multi-level government; institutional quality; long-term care; benefit targeting;
    All these keywords.

    JEL classification:

    • C13 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Estimation: General
    • H11 - Public Economics - - Structure and Scope of Government - - - Structure and Scope of Government
    • H53 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Welfare Programs
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination

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