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Subnational Health Spending and Soft Budget Constraints in OECD Countries

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  • Ernesto Crivelli
  • Adam Leive
  • Mr. Thomas Stratmann

Abstract

Government spending on health has grown as a percent of GDP over the last 40 years in industrialized countries. Widespread decentralization of healthcare systems has often accompanied this increase in spending. In this paper, we explore the effect of soft budget constraints on subnational health spending in a sample of OECD countries. We find countries where subnational governments rely primarily on central government financing and enjoy large borrowing autonomy have higher healthcare spending than those with more restrictions on subnational government borrowing.

Suggested Citation

  • Ernesto Crivelli & Adam Leive & Mr. Thomas Stratmann, 2010. "Subnational Health Spending and Soft Budget Constraints in OECD Countries," IMF Working Papers 2010/147, International Monetary Fund.
    • Handle: RePEc:imf:imfwpa:2010/147
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    References listed on IDEAS

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    1. Gerdtham, Ulf-G. & Jonsson, Bengt, 2000. "International comparisons of health expenditure: Theory, data and econometric analysis," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 1, pages 11-53, Elsevier.
    2. Teresa Ter-Minassian, 2007. "Fiscal Rules for Subnational Governments: Can They Promote Fiscal Discipline?," OECD Journal on Budgeting, OECD Publishing, vol. 6(3), pages 1-11.
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    Cited by:

    1. Jäger, Jannik & Grigoriadis, Theocharis, 2016. "Soft budget constraints, European Central Banking and the financial crisis," Discussion Papers 2016/7, Free University Berlin, School of Business & Economics.
    2. Anessi-Pessina, Eugenio & Steccolini, Ileana, 2024. "Do conformity and bailouts affect misreporting? The case of public health-care organisations," The British Accounting Review, Elsevier, vol. 56(3).
    3. János Kornai, 2014. "The soft budget constraint," Acta Oeconomica, Akadémiai Kiadó, Hungary, vol. 64(supplemen), pages 25-79, November.
    4. Kornai, János, 2014. "Bevezetés A puha költségvetési korlát című kötethez [Introduction to the author s volume entitled Soft Budget Constraint]," Közgazdasági Szemle (Economic Review - monthly of the Hungarian Academy of Sciences), Közgazdasági Szemle Alapítvány (Economic Review Foundation), vol. 0(7), pages 845-897.
    5. Eyraud, Luc & Lusinyan, Lusine, 2013. "Vertical fiscal imbalances and fiscal performance in advanced economies," Journal of Monetary Economics, Elsevier, vol. 60(5), pages 571-587.
    6. Joan Costa-i-Font, 2012. "Fiscal Federalism and European Health System Decentralization: A Perspective," LEQS – LSE 'Europe in Question' Discussion Paper Series 55, European Institute, LSE.
    7. Mr. Luc Eyraud & Ms. Lusine Lusinyan, 2011. "Decentralizing Spending More Than Revenue: Does it Hurt Fiscal Performance?," IMF Working Papers 2011/226, International Monetary Fund.
    8. Paul Van Rompuy, 2016. "Sub-national Tax Autonomy and Deficits: Empirical Results for 27 OECD Countries," Regional Studies, Taylor & Francis Journals, vol. 50(7), pages 1248-1259, July.
    9. Inaki Aldasoro & Mr. Mike Seiferling, 2014. "Vertical Fiscal Imbalances and the Accumulation of Government Debt," IMF Working Papers 2014/209, International Monetary Fund.
    10. Eduardo Banzon & Mathilde Mailfert, 2018. "Overcoming Public Sector Inefficiencies Toward Universal Health Coverage - The Case for National Health Insurance Systems in Asia and the Pacific," Working Papers id:12809, eSocialSciences.
    11. Afonso, António & Tovar Jalles, João & Venâncio, Ana, 2024. "Fiscal decentralization and public sector efficiency: Do natural disasters matter?," Economic Modelling, Elsevier, vol. 137(C).
    12. Karima Saleh, 2012. "World Bank study : A Health Sector in Transition to Universal Coverage in Ghana," World Bank Publications - Reports 2728, The World Bank Group.

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