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The Regional Impact of Health Care Expenditure: the Case of Italy


  • Margherita Giannoni
  • Theodore Hitiris


Decentralisation invests the sub-central authorities of a country with autonomy in political and economic power the exercise of which may widen interregional divergence and inequality. This paper provides evidence demonstrating that in the case of Italy the central government's policies for rationalisation and containment of the growth of health care expenditure in combination with decentralisation in the administration and provision of health care have resulted in interregional inequality, aggravating the existing regional divergence.

Suggested Citation

  • Margherita Giannoni & Theodore Hitiris, "undated". "The Regional Impact of Health Care Expenditure: the Case of Italy," Discussion Papers 99/20, Department of Economics, University of York.
  • Handle: RePEc:yor:yorken:99/20

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    References listed on IDEAS

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    Cited by:

    1. Cinzia Di Novi & Dino Rizzi & Michele Zanette, 2016. "Larger is Better: the Scale Effects of the Italian Local Healthcare Authorities Amalgamation Program," Working Papers 2016:04, Department of Economics, University of Venice "Ca' Foscari".
    2. Giardina, Emilio & Cavalieri, Marina & Guccio, Calogero & Mazza, Isidoro, 2009. "Federalism, Party Competition and Budget Outcome: Empirical Findings on Regional Health Expenditure in Italy," MPRA Paper 16437, University Library of Munich, Germany.
    3. Silvia Fedeli, 2012. "The impact of GDP on health care expenditure: the case of Italy (1982-2009)," Working Papers 153, University of Rome La Sapienza, Department of Public Economics.
    4. Guillem López & Joan Costa-Font & Ivan Planas, 2004. "Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'," Working Papers, Research Center on Health and Economics 745, Department of Economics and Business, Universitat Pompeu Fabra.
    5. Rita De Siano & Marcella D'Uva, 2013. "Does decentralization affect regional public spending in Italy?," Discussion Papers 1_2013, CRISEI, University of Naples "Parthenope", Italy.
    6. Jochen Hartwig & Jan-Egbert Sturm, 2017. "Testing the Grossman model of medical spending determinants with macroeconomic panel data," Chemnitz Economic Papers 001, Department of Economics, Chemnitz University of Technology, revised Feb 2017.
    7. Fabio Pammolli & Francesco Porcelli & Francesco Vidoli & Monica Auteri & Guido Borà, 2017. "La spesa sanitaria delle Regioni in Italia - Saniregio 2017," Working Papers CERM 01-2017, Competitività, Regole, Mercati (CERM).
    8. Jochen Hartwig & Jan-Egbert Sturm, 2012. "An outlier-robust extreme bounds analysis of the determinants of health-care expenditure growth," KOF Working papers 12-307, KOF Swiss Economic Institute, ETH Zurich.
    9. Padovano, Fabio, 2012. "The drivers of interregional policy choices: Evidence from Italy," European Journal of Political Economy, Elsevier, vol. 28(3), pages 324-340.
    10. David Bardey & Sylvain Pichetti, 2004. "Estimation de l'efficience des dépenses de santé au niveau départemental par la méthode DEA," Economie & Prévision, La Documentation Française, vol. 166(5), pages 59-69.
    11. Bech, Mickael & Lauridsen, Jørgen, 2008. "Exploring the spatial pattern in hospital admissions," Health Policy, Elsevier, vol. 87(1), pages 50-62, July.
    12. Joan Costa-Font & Gilberto Turati, 2016. "Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?," LEQS – LSE 'Europe in Question' Discussion Paper Series 113, European Institute, LSE.
    13. Serap Taskaya & Mustafa Demirkiran, 2016. "The Causality between Healthcare Resources and Health Expenditures in Turkey. A Granger Causality Method," International Journal of Academic Research in Accounting, Finance and Management Sciences, Human Resource Management Academic Research Society, International Journal of Academic Research in Accounting, Finance and Management Sciences, vol. 6(2), pages 98-103, April.
    14. Rinaldo Brau & Matteo Lippi Bruni & Anna Maria Pinna, 2010. "Public versus private demand for covering long-term care expenditures," Applied Economics, Taylor & Francis Journals, vol. 42(28), pages 3651-3668.
    15. Joan Costa-Font & Francesco Moscone, 2008. "The impact of decentralization and inter-territorial interactions on Spanish health expenditure," Empirical Economics, Springer, vol. 34(1), pages 167-184, February.
    16. Massimiliano Piacenza & Gilberto Turati, 2014. "Does Fiscal Discipline Towards Subnational Governments Affect Citizens' Well‐Being? Evidence On Health," Health Economics, John Wiley & Sons, Ltd., vol. 23(2), pages 199-224, February.
    17. Silvia Fedeli, 2015. "The Impact of GDP on Health Care Expenditure: The Case of Italy (1982–2009)," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 122(2), pages 347-370, June.
    18. David Cantarero, 2005. "Decentralization and health care expenditure: the Spanish case," Applied Economics Letters, Taylor & Francis Journals, vol. 12(15), pages 963-966.
    19. Mickael Bech & Jørgen Lauridsen, 2009. "Exploring spatial patterns in general practice expenditure," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(3), pages 243-254, July.
    20. Jochen Hartwig & Jan-Egbert Sturm, 2014. "Robust determinants of health care expenditure growth," Applied Economics, Taylor & Francis Journals, vol. 46(36), pages 4455-4474, December.
    21. David Prieto & Santiago Lago-Peñas, 2012. "Decomposing the determinants of health care expenditure: the case of Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 19-27, February.
    22. Massimo Bordignon & Gilberto Turati, 2003. "Bailing Out Expectations and Health Expenditure in Italy," CESifo Working Paper Series 1026, CESifo Group Munich.
    23. Bordignon, Massimo & Turati, Gilberto, 2009. "Bailing out expectations and public health expenditure," Journal of Health Economics, Elsevier, vol. 28(2), pages 305-321, March.
    24. Vandersteegen, Tom & Marneffe, Wim & Cleemput, Irina & Vereeck, Lode, 2015. "The impact of no-fault compensation on health care expenditures: An empirical study of OECD countries," Health Policy, Elsevier, vol. 119(3), pages 367-374.
    25. Nilgun Yavuz & Veli Yilanci & Zehra Ozturk, 2013. "Is health care a luxury or a necessity or both? Evidence from Turkey," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 5-10, February.

    More about this item


    regional divergence; health care expenditure.;

    JEL classification:

    • R51 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - Regional Government Analysis - - - Finance in Urban and Rural Economies
    • I10 - Health, Education, and Welfare - - Health - - - General

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