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Allocation of authority in European health policy

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  • Adolph, Christopher
  • Greer, Scott L.
  • Massard da Fonseca, Elize

Abstract

Although many study the effects of different allocations of health policy authority, few ask why countries assign responsibility over different policies as they do. We test two broad theories: fiscal federalism, which predicts rational governments will concentrate information-intensive operations at lower levels, and redistributive and regulatory functions at higher levels; and “politicized federalism”, which suggests a combination of systematic and historically idiosyncratic political variables interfere with efficient allocation of authority. Drawing on the WHO Health in Transition country profiles, we present new data on the allocation of responsibility for key health care policy tasks (implementation, provision, finance, regulation, and framework legislation) and policy areas (primary, secondary and tertiary care, public health and pharmaceuticals) in the 27 EU member states and Switzerland. We use a Bayesian multinomial mixed logit model to analyze how different countries arrive at different allocations of authority over each task and area of health policy, and find the allocation of powers broadly follows fiscal federalism. Responsibility for pharmaceuticals, framework legislation, and most finance lodges at the highest levels of government, acute and primary care in the regions, and provision at the local and regional levels. Where allocation does not follow fiscal federalism, it appears to reflect ethnic divisions, the population of states and regions, the presence of mountainous terrain, and the timing of region creation.

Suggested Citation

  • Adolph, Christopher & Greer, Scott L. & Massard da Fonseca, Elize, 2012. "Allocation of authority in European health policy," Social Science & Medicine, Elsevier, vol. 75(9), pages 1595-1603.
  • Handle: RePEc:eee:socmed:v:75:y:2012:i:9:p:1595-1603
    DOI: 10.1016/j.socscimed.2012.05.041
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    References listed on IDEAS

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    2. Berta, Paolo & Guerriero, Carla & Levaggi, Rosella, 2021. "Hospitals’ strategic behaviours and patient mobility: Evidence from Italy," Socio-Economic Planning Sciences, Elsevier, vol. 77(C).
    3. Klasa, Katarzyna & Greer, Scott L. & van Ginneken, Ewout, 2018. "Strategic Purchasing in Practice: Comparing Ten European Countries," Health Policy, Elsevier, vol. 122(5), pages 457-472.
    4. Paolo Berta & Carla Guerriero & Rosella Levaggi, 2018. "The dark side of fiscal federalism:evidence from hospital care in Italy," Working papers 72, Società Italiana di Economia Pubblica.
    5. Emanuela Marrocu & Silvia Balia & Rinaldo Brau, 2016. "A spatial analysis of inter-regional patient mobility in Italy," ERSA conference papers ersa16p127, European Regional Science Association.
    6. Rubino, Claudio & Di Maria, Chiara & Abbruzzo, Antonino & Ferrante, Mauro, 2022. "Socio-economic inequality, interregional mobility and mortality among cancer patients: A mediation analysis approach," Socio-Economic Planning Sciences, Elsevier, vol. 82(PA).

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