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Decentralization of health care systems and health outcomes: Evidence from a natural experiment

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  • Jiménez-Rubio, Dolores
  • García-Gómez, Pilar

Abstract

While many countries worldwide are shifting responsibilities for their health systems to local levels of government, there is to date insufficient evidence about the potential impact of these policy reforms. We estimate the impact of decentralization of the health services on infant and neonatal mortality using a natural experiment: the devolution of health care decision making powers to Spanish regions. The devolution was implemented gradually and asymmetrically over a twenty-year period (1981–2002). The order in which the regions were decentralized was driven by political factors and hence can be considered exogenous to health outcomes. In addition, we exploit the dynamic effect of decentralization of health services and allow for heterogeneous effects by the two main types of decentralization implemented across regions: full decentralization (political and fiscal powers) versus political decentralization only. Our difference in differences results based on a panel dataset for the 50 Spanish provinces over the period 1980 to 2010 show that the lasting benefit of decentralization accrues only to regions which enjoy almost full fiscal and political powers and which are also among the richest regions.

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  • Jiménez-Rubio, Dolores & García-Gómez, Pilar, 2017. "Decentralization of health care systems and health outcomes: Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 188(C), pages 69-81.
    • Handle: RePEc:eee:socmed:v:188:y:2017:i:c:p:69-81
    DOI: 10.1016/j.socscimed.2017.06.041
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    1. Daron Acemoglu & Davide Cantoni & Simon Johnson & James A. Robinson, 2011. "The Consequences of Radical Reform: The French Revolution," American Economic Review, American Economic Association, vol. 101(7), pages 3286-3307, December.
    2. Alain Cuenca, 2015. "Las entregas a cuenta en el sistema de financiación de las CCAA de régimen común: problemas y opciones de mejora," Policy Papers 2015-10, FEDEA.
    3. Isabelle Joumard & Christophe André & Chantal Nicq, 2010. "Health Care Systems: Efficiency and Institutions," OECD Economics Department Working Papers 769, OECD Publishing.
    4. Uchimura, Hiroko & Jütting, Johannes P., 2009. "Fiscal Decentralization, Chinese Style: Good for Health Outcomes?," World Development, Elsevier, vol. 37(12), pages 1926-1934, December.
    5. Rodden, Jonathan, 2003. "Reviving Leviathan: Fiscal Federalism and the Growth of Government," International Organization, Cambridge University Press, vol. 57(4), pages 695-729, October.
    6. Nadir Habibi & Cindy Huang & Diego Miranda & Victoria Murillo & Gustav Ranis & Mainak Sarkar & Frances Stewart, 2003. "Decentralization and Human Development in Argentina," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 4(1), pages 73-101.
    7. Dolores Jimenez Rubio, 2011. "The impact of decentralization of health services on health outcomes: evidence from Canada," Applied Economics, Taylor & Francis Journals, vol. 43(26), pages 3907-3917.
    8. 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.
    9. Besley, Timothy & Coate, Stephen, 2003. "Centralized versus decentralized provision of local public goods: a political economy approach," Journal of Public Economics, Elsevier, vol. 87(12), pages 2611-2637, December.
    10. Montero-Granados, Roberto & de Dios Jiménez, Juan & Martín, José, 2007. "Decentralisation and convergence in health among the provinces of Spain (1980-2001)," Social Science & Medicine, Elsevier, vol. 64(6), pages 1253-1264, March.
    11. Timothy Besley & Masayuki Kudamatsu, 2006. "Health and Democracy," American Economic Review, American Economic Association, vol. 96(2), pages 313-318, May.
    12. D. Cantarero & Marta Pascual, 2007. "Analysing the impact of fiscal decentralization on health outcomes: empirical evidence from Spain," Applied Economics Letters, Taylor & Francis Journals, vol. 15(2), pages 109-111.
    13. José-Ignacio Antón & Rafael Muñoz de Bustillo & Enrique Fernández Macías & Jesús Rivera, 2014. "Effects of health care decentralization in Spain from a citizens’ perspective," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 411-431, May.
    14. Mr. Ehtisham Ahmad & Mr. Giorgio Brosio & Mr. Vito Tanzi, 2008. "Local Service Provision in Selected OECD Countries: Do Decentralized Operations Work Better?," IMF Working Papers 2008/067, International Monetary Fund.
    15. Cavalieri, Marina & Ferrante, Livio, 2016. "Does fiscal decentralization improve health outcomes? Evidence from infant mortality in Italy," Social Science & Medicine, Elsevier, vol. 164(C), pages 74-88.
    16. Guillem Lopez‐Casasnovas & Joan Costa‐Font & Ivan Planas, 2005. "Diversity and regional inequalities in the Spanish ‘system of health care services’," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 221-235, September.
    17. Abay Asfaw* & Klaus Frohberg & KS James & Johannes Jütting, 2007. "Fiscal decentralization and infant mortality: empirical evidence from r ural India," Journal of Developing Areas, Tennessee State University, College of Business, vol. 41(1), pages 17-35, September.
    18. Robalino, David A. & Picazo, Oscar F. & Voetberg, Albertus, 2001. "Does fiscal decentralization improve health outcomes? - evidence from a cross-country analysis," Policy Research Working Paper Series 2565, The World Bank.
    19. Justin Wolfers, 2006. "Did Unilateral Divorce Laws Raise Divorce Rates? A Reconciliation and New Results," American Economic Review, American Economic Association, vol. 96(5), pages 1802-1820, December.
    20. Soto, Victoria Eugenia & Farfan, Maria Isabel & Lorant, Vincent, 2012. "Fiscal decentralisation and infant mortality rate: The Colombian case," Social Science & Medicine, Elsevier, vol. 74(9), pages 1426-1434.
    21. Jiménez-Rubio, Dolores, 2011. "The impact of fiscal decentralization on infant mortality rates: Evidence from OECD countries," Social Science & Medicine, Elsevier, vol. 73(9), pages 1401-1407.
    22. Paolo Liberati & Agnese Sacchi, 2013. "Tax decentralization and local government size," Public Choice, Springer, vol. 157(1), pages 183-205, October.
    23. 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.
    24. Khaleghian, Peyvand, 2004. "Decentralization and public services: the case of immunization," Social Science & Medicine, Elsevier, vol. 59(1), pages 163-183, July.
    25. Bossert, Thomas John & Mitchell, Andrew David, 2011. "Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan," Social Science & Medicine, Elsevier, vol. 72(1), pages 39-48, January.
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