IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v71y2010i5p925-934.html
   My bibliography  Save this article

The tradeoff between centralized and decentralized health services: Evidence from rural areas in Mexico

Author

Listed:
  • Vargas Bustamante, Arturo

Abstract

This study investigates the effectiveness of centralized and decentralized health care providers in rural Mexico. It compares provider performance since both centralized and decentralized providers co-exist in rural areas of the country. The data are drawn from the 2003 household survey of Oportunidades, a comprehensive study of rural families from seven states in Mexico. The analyses compare out-of-pocket health care expenditures and utilization of preventive care among rural households with access to either centralized or decentralized health care providers. This study benefits from differences in timing of health care decentralization and from a quasi-random distribution of providers. Results show that overall centralized providers perform better. Households served by this organization report less regressive out-of-pocket health care expenditures (32% lower), and observe higher utilization of preventive services (3.6% more). Decentralized providers that were devolved to state governments in the early 1980s observe a slightly better performance than providers that were decentralized in the mid-1990s. These findings are robust to decentralization timing, heterogeneity in per capita government health expenditures, state and health infrastructure effects, and other confounders.

Suggested Citation

  • Vargas Bustamante, Arturo, 2010. "The tradeoff between centralized and decentralized health services: Evidence from rural areas in Mexico," Social Science & Medicine, Elsevier, vol. 71(5), pages 925-934, September.
    • Handle: RePEc:eee:socmed:v:71:y:2010:i:5:p:925-934
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(10)00421-1
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Yingyi Qian & Gerard Roland & Chenggang Xu, 2006. "Coordination and Experimentation in M-Form and U-Form Organizations," Journal of Political Economy, University of Chicago Press, vol. 114(2), pages 366-402, April.
    2. Edward C. Norton & Hua Wang & Chunrong Ai, 2004. "Computing interaction effects and standard errors in logit and probit models," Stata Journal, StataCorp LP, vol. 4(2), pages 154-167, June.
    3. Faguet, Jean-Paul, 2004. "Does decentralization increase government responsiveness to local needs?: Evidence from Bolivia," Journal of Public Economics, Elsevier, vol. 88(3-4), pages 867-893, March.
    4. 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.
    5. Pranab Bardhan, 2002. "Decentralization of Governance and Development," Journal of Economic Perspectives, American Economic Association, vol. 16(4), pages 185-205, Fall.
    6. Abhijit Banerjee & Angus Deaton & Esther Duflo, 2004. "Wealth, Health, and Health Services in Rural Rajasthan," American Economic Review, American Economic Association, vol. 94(2), pages 326-330, May.
    7. Martin L. Weitzman, 1974. "Prices vs. Quantities," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 41(4), pages 477-491.
    8. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    9. Kristiansen, Stein & Santoso, Purwo, 2006. "Surviving decentralisation?: Impacts of regional autonomy on health service provision in Indonesia," Health Policy, Elsevier, vol. 77(3), pages 247-259, August.
    10. Lee, Myoung-jae, 2005. "Micro-Econometrics for Policy, Program and Treatment Effects," OUP Catalogue, Oxford University Press, number 9780199267699, December.
    11. Alec Ian Gershberg & Michael Jacobs, 1998. "Decentralization and Recentralization: Lessons from the Social Sectors in Mexico and Nicaragua," IDB Publications (Working Papers) 6441, Inter-American Development Bank.
    12. Homedes, Nuria & Ugalde, Antonio, 2005. "Why neoliberal health reforms have failed in Latin America," Health Policy, Elsevier, vol. 71(1), pages 83-96, January.
    13. Bossert, Thomas, 1998. "Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance," Social Science & Medicine, Elsevier, vol. 47(10), pages 1513-1527, November.
    14. Bolton, Patrick & Farrell, Joseph, 1990. "Decentralization, Duplication, and Delay," Journal of Political Economy, University of Chicago Press, vol. 98(4), pages 803-826, August.
    15. Bardhan, Pranab & Mookherjee, Dilip, 2005. "Decentralizing antipoverty program delivery in developing countries," Journal of Public Economics, Elsevier, vol. 89(4), pages 675-704, April.
    16. Khaleghian, Peyvand, 2004. "Decentralization and public services: the case of immunization," Social Science & Medicine, Elsevier, vol. 59(1), pages 163-183, July.
    17. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Makokha, Racheal Omukhulu, 2017. "Does Decentralization Improve Provision of Health Services? Evidence from Kisumu and Makueni Counties in Kenya," Thesis Commons xef7a, Center for Open Science.
    2. Park, Sungchul & Lee, Jason & Ikai, Hiroshi & Otsubo, Tetsuya & Imanaka, Yuichi, 2013. "Decentralization and centralization of healthcare resources: Investigating the associations of hospital competition and number of cardiologists per hospital with mortality and resource utilization in ," Health Policy, Elsevier, vol. 113(1), pages 100-109.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Kis-Katos, Krisztina & Sjahrir, Bambang Suharnoko, 2017. "The impact of fiscal and political decentralization on local public investment in Indonesia," Journal of Comparative Economics, Elsevier, vol. 45(2), pages 344-365.
    2. Makokha, Racheal Omukhulu, 2017. "Does Decentralization Improve Provision of Health Services? Evidence from Kisumu and Makueni Counties in Kenya," Thesis Commons xef7a, Center for Open Science.
    3. Grégoire ROTA-GRAZIOSI & Emilie CALDEIRA, 2014. "La décentralisation dans les pays en développement : une revue de la littérature - Decentralization in developing countries: A literature review," Working Papers 201411, CERDI.
    4. Reingewertz, Yaniv, 2014. "Fiscal Decentralization - a Survey of the Empirical Literature," MPRA Paper 59889, University Library of Munich, Germany.
    5. Emilie Caldeira & Martial Foucault & Grégoire Rota-Graziosi, 2014. "Does Decentralization Facilitate Access to Poverty-Related Services? Evidence from Benin," NBER Chapters, in: African Successes, Volume I: Government and Institutions, pages 57-102, National Bureau of Economic Research, Inc.
    6. Emilie Caldeira & Grégoire Rota-Graziosi, 2015. "La décentralisation dans les pays en développement : une revue de la littérature - Decentralization in developing countries: A literature review," CERDI Working papers halshs-01005204, HAL.
    7. Trottmann, Maria & Zweifel, Peter & Beck, Konstantin, 2012. "Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?," Journal of Health Economics, Elsevier, vol. 31(1), pages 231-242.
    8. Emilie Caldeira & Martial Foucault & Gregoire Rota-Graziosi, 2015. "Decentralization in Africa and the nature of local governments’ competition: evidence from Benin," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 22(6), pages 1048-1076, December.
    9. Besfamille, Martin & Lockwood, Ben, 2004. "Are Hard Budget Constraints for Sub-National Governments Always Efficient?," The Warwick Economics Research Paper Series (TWERPS) 717, University of Warwick, Department of Economics.
    10. 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.
    11. Galiani, Sebastian & Gertler, Paul & Schargrodsky, Ernesto, 2008. "School decentralization: Helping the good get better, but leaving the poor behind," Journal of Public Economics, Elsevier, vol. 92(10-11), pages 2106-2120, October.
    12. Evan Plous Kresch, 2020. "The Buck Stops Where? Federalism, Uncertainty, and Investment in the Brazilian Water and Sanitation Sector," American Economic Journal: Economic Policy, American Economic Association, vol. 12(3), pages 374-401, August.
    13. Bo, Shiyu & Cheng, Chao, 2021. "Political hierarchy and urban primacy: Evidence from China," Journal of Comparative Economics, Elsevier, vol. 49(4), pages 933-946.
    14. Manabu Nose, 2022. "Decentralized provision of disaster aid: aid fragmentation and the poverty implications," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 29(5), pages 1098-1127, October.
    15. repec:hal:wpspec:info:hdl:2441/53r60a8s3kup1vc9k2cag6dp8 is not listed on IDEAS
    16. Han, Li, 2013. "Is centralized teacher deployment more equitable? Evidence from rural China," China Economic Review, Elsevier, vol. 24(C), pages 65-76.
    17. repec:hal:spmain:info:hdl:2441/53r60a8s3kup1vc9k2cag6dp8 is not listed on IDEAS
    18. Chowdhury, Shyamnal & Yamauchi, Futoshi & Dewina, Reno, 2009. "Governance decentralization and local infrastructure provision in Indonesia:," IFPRI discussion papers 902, International Food Policy Research Institute (IFPRI).
    19. Park, Albert & Wang, Sangui, 2010. "Community-based development and poverty alleviation: An evaluation of China's poor village investment program," Journal of Public Economics, Elsevier, vol. 94(9-10), pages 790-799, October.
    20. Tiangboho Sanogo, 2019. "Does fiscal decentralization enhance citizens’ access to public services and reduce poverty? Evidence from Côte d’Ivoire municipalities in a conflict setting," Post-Print hal-01875189, HAL.
    21. repec:spo:wpecon:info:hdl:2441/53r60a8s3kup1vc9k2cag6dp8 is not listed on IDEAS
    22. Zelda Brutti, 2016. "Cities drifting apart: Heterogeneous outcomes of decentralizing public education," Working Papers 2016/26, Institut d'Economia de Barcelona (IEB).
    23. repec:spo:wpmain:info:hdl:2441/53r60a8s3kup1vc9k2cag6dp8 is not listed on IDEAS
    24. Brutti Zelda, 2020. "Cities drifting apart: Heterogeneous outcomes of decentralizing public education," IZA Journal of Labor Economics, Sciendo & Forschungsinstitut zur Zukunft der Arbeit GmbH (IZA), vol. 9(1), pages 1-38, January.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:71:y:2010:i:5:p:925-934. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.