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

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  • 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.

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  • 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
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    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.
    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.
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    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.

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