IDEAS home Printed from https://ideas.repec.org/a/spr/eujhec/v15y2014i4p411-431.html
   My bibliography  Save this article

Effects of health care decentralization in Spain from a citizens’ perspective

Author

Listed:
  • José-Ignacio Antón
  • Rafael Muñoz de Bustillo
  • Enrique Fernández Macías
  • Jesús Rivera

Abstract

The aim of this article is to analyze the impact of the decentralization of the public national health system in Spain on citizens’ satisfaction with different dimensions of primary and hospital care. Using micro-data from the Health Barometer 1996–2009 and taking advantage of the exogeneity of the different pace of decentralization across Spain using a difference-in-differences strategy, we find that, in general, decentralization has not improved citizens’ satisfaction with different features of the health services. In our base model, we find that there are even some small negative effects on a subset of variables. Sensitivity analysis confirms that there is no empirical evidence for supporting that decentralization has had a positive impact on citizens’ satisfaction with health care. We outline several possible reasons for this. Copyright Springer-Verlag Berlin Heidelberg 2014

Suggested Citation

  • 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.
    • Handle: RePEc:spr:eujhec:v:15:y:2014:i:4:p:411-431
    DOI: 10.1007/s10198-013-0485-0
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.1007/s10198-013-0485-0
    Download Restriction: Access to full text is restricted to subscribers.
    File URL: https://libkey.io/10.1007/s10198-013-0485-0?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

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

    Other versions of this item:

    References listed on IDEAS

    as
    1. Eli Noam, 1982. "The Choice Of Governmental Level In Regulation," Kyklos, Wiley Blackwell, vol. 35(2), pages 278-291, May.
    2. Joan Costa‐Font & Jordi Pons‐Novell, 2007. "Public health expenditure and spatial interactions in a decentralized national health system," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 291-306, March.
    3. Stephen G. Donald & Kevin Lang, 2007. "Inference with Difference-in-Differences and Other Panel Data," The Review of Economics and Statistics, MIT Press, vol. 89(2), pages 221-233, May.
    4. Sebastian Galiani & Ernesto Schargrodsky, 2002. "Evaluating the Impact of School Decentralization on Educational Quality," Economía Journal, The Latin American and Caribbean Economic Association - LACEA, vol. 0(Spring 20), pages 275-314, January.
    5. Paula Salinas Pena & Albert Sole-Olle, 2009. "Evaluating the effects of decentralization on educational outcomes in Spain," Working Papers in Economics 228, Universitat de Barcelona. Espai de Recerca en Economia.
    6. Tudorel Andrei & Constantin Mitrut & Daniela L. Constantin & Bogdan Oancea, 2009. "The Impact of Decentralization on Public Health System’s Results. The Case of Romania," Theoretical and Applied Economics, Asociatia Generala a Economistilor din Romania / Editura Economica, vol. 10(10(539)), pages 17-22, October.
    7. Charles M. Tiebout, 1956. "A Pure Theory of Local Expenditures," Journal of Political Economy, University of Chicago Press, vol. 64(5), pages 416-416.
    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. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(1), pages 249-275.
    10. Mark Hellowell & Allyson M. Pollock, 2009. "The Private Financing Of Nhs Hospitals: Politics, Policy And Practice," Economic Affairs, Wiley Blackwell, vol. 29(1), pages 13-19, March.
    11. López-Casasanovas, Guillem, 2007. "Organizational innovations and health care decentralization: a perspective from Spain," Health Economics, Policy and Law, Cambridge University Press, vol. 2(2), pages 223-232, April.
    12. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Economics and Management, Springer, vol. 10(3), pages 219-237, September.
    13. Joan Costa-Font & Ana Rico, 2006. "Devolution and the Interregional Inequalities in Health and Healthcare in Spain," Regional Studies, Taylor & Francis Journals, vol. 40(8), pages 875-887.
    14. Deirdre N. McCloskey & Stephen T. Ziliak, 1996. "The Standard Error of Regressions," Journal of Economic Literature, American Economic Association, vol. 34(1), pages 97-114, March.
    15. Lee, Myoung-jae, 2005. "Micro-Econometrics for Policy, Program and Treatment Effects," OUP Catalogue, Oxford University Press, number 9780199267699.
    16. 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.
    17. 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.
    18. Hansen, Christian B., 2007. "Generalized least squares inference in panel and multilevel models with serial correlation and fixed effects," Journal of Econometrics, Elsevier, vol. 140(2), pages 670-694, October.
    19. 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.
    20. Dolores Jiménez‐Rubio & Peter C. Smith & Eddy Van Doorslaer, 2008. "Equity in health and health care in a decentralised context: evidence from Canada," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 377-392, March.
    21. Khaleghian, Peyvand, 2003. "Decentralization and public services : the case of immunization," Policy Research Working Paper Series 2989, The World Bank.
    22. repec:bla:kyklos:v:35:y:1982:i:2:p:278-91 is not listed on IDEAS
    23. Shahidur R. Khandker & Gayatri B. Koolwal & Hussain A. Samad, . "Handbook on Impact Evaluation : Quantitative Methods and Practices," World Bank Publications, The World Bank, number 2693, September.
    24. Ferrario, Caterina & Zanardi, Alberto, 2011. "Fiscal decentralization in the Italian NHS: What happens to interregional redistribution?," Health Policy, Elsevier, vol. 100(1), pages 71-80, April.
    25. Xosé Carlos Arias Moreira & Santiago Lago Peñas, 2005. "Las relaciones entre descentralización y capital social: argumentos teóricos y referencia española," EKONOMIAZ. Revista vasca de Economía, Gobierno Vasco / Eusko Jaurlaritza / Basque Government, vol. 59(02), pages 118-135.
    26. John Akin & Paul Hutchinson & Koleman Strumpf, 2005. "Decentralisation and government provision of public goods: The public health sector in Uganda," Journal of Development Studies, Taylor & Francis Journals, vol. 41(8), pages 1417-1443.
    27. Paula Salinas Pena & Albert Sole-Olle, 2009. "Evaluating the effects of decentralization on educational outcomes in Spain," Working Papers in Economics 228, Universitat de Barcelona. Espai de Recerca en Economia.
    28. David Cantarero Prieto & Marta Pascual Saez, "undated". "Decentralisation and health care outcomes: An empirical analysis within the European Union," Studies on the Spanish Economy 220, FEDEA.
    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. Ryota Nakatani & Qianqian Zhang & Isaura Garcia Valdes, 2022. "Fiscal Decentralization Improves Social Outcomes When Countries Have Good Governance," IMF Working Papers 2022/111, International Monetary Fund.
    2. Leonardo E. Letelier-S & José L. Sáez-Lozano, 2020. "Expenditure Decentralization: Does It Make Us Happier? An Empirical Analysis Using a Panel of Countries," Sustainability, MDPI, vol. 12(18), pages 1-17, September.
    3. 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.
    4. Cinzia Di Novi & Massimiliano Piacenza & Silvana Robone & Gilberto Turati, 2015. "How does fiscal decentralization affect within-regional disparities in well-being? Evidence from health inequalities in Italy," Working Papers 2015:21, Department of Economics, University of Venice "Ca' Foscari".
    5. García-Corchero, Juan David & Jiménez-Rubio, Dolores, 2022. "How do policy levers shape the quality of a national health system?," Journal of Policy Modeling, Elsevier, vol. 44(1), pages 203-221.
    6. Ryota Nakatani & Qianqian Zhang & Isaura Garcia Valdes, 2024. "Health Expenditure Decentralization and Health Outcomes: The Importance of Governance," Publius: The Journal of Federalism, CSF Associates Inc., vol. 54(1), pages 59-87.
    7. Mauro, Marianna & Maresso, Anna & Guglielmo, Annamaria, 2017. "Health decentralization at a dead-end: towards new recovery plans for Italian hospitals," LSE Research Online Documents on Economics 74066, London School of Economics and Political Science, LSE Library.

    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. Leonardo Letelier S & Hector Ormeño C, 2018. "Education and fiscal decentralization. The case of municipal education in Chile," Environment and Planning C, , vol. 36(8), pages 1499-1521, December.
    2. Yue Dong & Dipanwita Sarkar & Jayanta Sarkar, 2021. "Decentralization and health resource allocation: Quasi-experimental evidence from China," QuBE Working Papers 060, QUT Business School.
    3. Di Novi, C. & Piacenza, M. & Robone, S. & Turati, G., 2015. "How does fiscal decentralization affect within-regional disparities in well-being? Evidence from health inequalities in Italy," Health, Econometrics and Data Group (HEDG) Working Papers 15/23, HEDG, c/o Department of Economics, University of York.
    4. Guido W. Imbens & Jeffrey M. Wooldridge, 2009. "Recent Developments in the Econometrics of Program Evaluation," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 5-86, March.
    5. Paula Salinas & Albert Solé-Ollé, 2009. "Evaluating the effects of decentralization on educational outcomes in Spain," Working Papers 2009/10, Institut d'Economia de Barcelona (IEB).
    6. Jeong, Dong Wook & Lee, Ho Jun & Cho, Sung Kyung, 2017. "Education decentralization, school resources, and student outcomes in Korea," International Journal of Educational Development, Elsevier, vol. 53(C), pages 12-27.
    7. Ryota Nakatani & Qianqian Zhang & Isaura Garcia Valdes, 2024. "Health Expenditure Decentralization and Health Outcomes: The Importance of Governance," Publius: The Journal of Federalism, CSF Associates Inc., vol. 54(1), pages 59-87.
    8. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Economics and Management, Springer, vol. 10(3), pages 219-237, September.
    9. Sumah, Anthony Mwinkaara & Baatiema, Leonard & Abimbola, Seye, 2016. "The impacts of decentralisation on health-related equity: A systematic review of the evidence," Health Policy, Elsevier, vol. 120(10), pages 1183-1192.
    10. Masayoshi Hayashi, 2011. "The effects of medical factors on transfer deficits in Public Assistance in Japan: a quantile regression analysis," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 287-307, December.
    11. Ligthart, Jenny E. & van Oudheusden, Peter, 2015. "In government we trust: The role of fiscal decentralization," European Journal of Political Economy, Elsevier, vol. 37(C), pages 116-128.
    12. Atella, Vincenzo & Braione, Manuela & Ferrara, Giancarlo & Resce, Giuliano, 2023. "Cohesion Policy Funds and local government autonomy: Evidence from Italian municipalities," Socio-Economic Planning Sciences, Elsevier, vol. 87(PB).
    13. Diaz-Serrano, Luis & Meix-Llop, Enric, 2012. "Do Fiscal and Political Decentralization Raise Students' Performance? A Cross-Country Analysis," IZA Discussion Papers 6722, Institute of Labor Economics (IZA).
    14. Michele Cincera & Antonio Estache & Wolf Alexander, 2012. "Would Less Fiscal Decentralization Reduce Public Sector Size across Sectors in Europe ?," Working Papers ECARES ECARES 2012-028, ULB -- Universite Libre de Bruxelles.
    15. Fabiana Machado, 2013. "Decentralization and Accountability: The Curse of Local Underdevelopment," Research Department Publications IDB-WP-397, Inter-American Development Bank, Research Department.
    16. Belman, Dale. & Wolfson, Paul J., 2016. "What does the minimum wage do in developing countries? : A review of studies and methodologies," ILO Working Papers 994893283402676, International Labour Organization.
    17. Dolores Jimenez & Peter C Smith, "undated". "Decentralisation of health care and its impact on health outcomes," Discussion Papers 05/10, Department of Economics, University of York.
    18. Brewer, Mike & Crossley, Thomas F. & Zilio, Federico, 2019. "What Do We Really Know about the Employment Effects of the UK's National Minimum Wage?," IZA Discussion Papers 12369, Institute of Labor Economics (IZA).
    19. Maldonado, Stanislao, 2014. "The Non-Monotonic Political Effects of Resource Booms," MPRA Paper 85649, University Library of Munich, Germany, revised 18 Dec 2017.
    20. Floriana Cerniglia & Riccarda Longaretti, 2013. "Federalism, education-related public good and growth when agents are heterogeneous," Journal of Economics, Springer, vol. 109(3), pages 271-301, July.

    More about this item

    Keywords

    Health care; Decentralization; Spain; Citizens’ satisfaction; H51; H75; I11;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H11 - Public Economics - - Structure and Scope of Government - - - Structure and Scope of Government
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare

    Statistics

    Access and download statistics

    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:spr:eujhec:v:15:y:2014:i:4:p:411-431. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    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.