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Does Decentralization Matter in Health Outcomes? Evidence from 22 OECD Unbalanced Panel Data for 1995–2005

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  • Youngju Kang
  • Wonhyuk Cho
  • Kwangho Jung

Abstract

Recently, scholars and practitioners around the globe have started to view decentralization as an integral part of broader health reforms. Nevertheless, the literature on decentralization has tended toward case studies and theoretical discussions rather than rigorous empirical analysis, and few quantitative studies have explored the practical consequences of decentralization of health service delivery. This study attempts to address this issue by exploring the impact of decentralization on health outcomes with a panel dataset of 22 countries from 1990 to 2005. Our findings indicate healthcare decentralization is nonlinearly beneficial to improve the health of a population. The effect of decentralization on population health remains positive within a certain threshold, but becomes negative beyond the transition point. Considering the institutional background of healthcare, the institutional setting of reliance on market mechanisms in service provision and on private insurance for basic coverage is a precondition for decentralization reform to further create a positive impact.

Suggested Citation

  • Youngju Kang & Wonhyuk Cho & Kwangho Jung, 2012. "Does Decentralization Matter in Health Outcomes? Evidence from 22 OECD Unbalanced Panel Data for 1995–2005," International Review of Public Administration, Taylor & Francis Journals, vol. 17(1), pages 1-32, April.
    • Handle: RePEc:taf:rrpaxx:v:17:y:2012:i:1:p:1-32
    DOI: 10.1080/12264431.2012.10805215
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    1. Nadir Habibi & Cindy Huang & Diego Miranda & Victoria Murillo & Gustav Ranis & Mainak Sarkar & Frances Stewart, 2001. "Decentralization in Argentina," Working Papers 825, Economic Growth Center, Yale University.
    2. Ulrich Thießen, 2003. "Fiscal Decentralisation and Economic Growth in High-Income OECD Countries," Fiscal Studies, Institute for Fiscal Studies, vol. 24(3), pages 237-274, September.
    3. Huther, Jeff & Shah, Anwar, 1998. "Applying a simple measure of good governance to the debate on fiscal decentralization," Policy Research Working Paper Series 1894, The World Bank.
    4. Ulrich Thießen, 2000. "Fiscal Federalism in Western European and Selected Other Countries: Centralization or Decentralization? What Is Better for Economic Growth?," Discussion Papers of DIW Berlin 224, DIW Berlin, German Institute for Economic Research.
    5. Khaleghian, Peyvand, 2004. "Decentralization and public services: the case of immunization," Social Science & Medicine, Elsevier, vol. 59(1), pages 163-183, July.
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    Cited by:

    1. Antonio José Orozco-Gallo, 2017. "Un análisis del gasto público en salud de los entes territoriales colombianos," Chapters, in: Jaime Bonet & Karelys Guzmán-Finol & Lucas Wilfried Hahn-De-Castro (ed.), La salud en Colombia: una perspectiva regional, chapter 10, pages 315-364, Banco de la Republica de Colombia.

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