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How does fiscal decentralization affect within-regional disparities in well-being? Evidence from health inequalities in Italy

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  • Di Novi, C.
  • Piacenza, M.
  • Robone, S.
  • Turati, G.

Abstract

This paper aims at investigating empirically the impact of fiscal decentralization reforms on inequality in well-being. In particular, we look at the effects on health inequalities following the assignment of larger tax power to the Italian Regions for financing their health expenditure, starting from the end of the Nineties. Exploiting large differences in the size of the tax base across Regions, we find that fiscal decentralization processes that attribute a greater tax power to lower government tiers, besides reducing inefficiencies of healthcare policies, seem to be effective in reducing also within-regional disparities in health outcomes. However, thedegree of economic development – on which depends the actual fiscal autonomy from Central government – significantly affects the effectiveness of these reforms and highlights the importance to take properly into account the specific features of the context where the decentralization of power is implemented.

Suggested Citation

  • 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.
    • Handle: RePEc:yor:hectdg:15/23
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    1. Antonio Abatemarco & Sergio Beraldo & Francesca Stroffolini, 2016. "A Resource-Sensitive Framework for Defining and Measuring Equality of Opportunity in Health," CSEF Working Papers 437, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    2. Maria Lucia Specchia & Andrea Di Pilla & Martina Sapienza & Maria Teresa Riccardi & Americo Cicchetti & Gianfranco Damiani & Instant Report Group, 2021. "Dealing with COVID-19 Epidemic in Italy: Responses from Regional Organizational Models during the First Phase of the Epidemic," IJERPH, MDPI, vol. 18(9), pages 1-14, May.
    3. Silvia Bruzzi & Enrico Ivaldi & Marta Santagata, 2022. "Measuring Regional Performance in the Italian NHS: Are Disparities Decreasing?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 159(3), pages 1057-1084, February.
    4. Signorelli, C. & Odone, A. & Oradini-Alacreu, A. & Pelissero, G., 2020. "Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary," Health Policy, Elsevier, vol. 124(1), pages 69-74.
    5. Antonio Nuzzo & Flavia Carle & Eugenio Anessi Pessina, 2018. "Processo di decentramento del SSN ed evoluzione dell?equit? interregionale nell?assistenza sanitaria nel periodo 2001-2012," MECOSAN, FrancoAngeli Editore, vol. 2018(108), pages 9-34.
    6. Luciana Aimone Gigio & Demetrio Alampi & Silvia Camussi & Giuseppe Ciaccio & Paolo Guaitini & Maurizio Lozzi & Anna Laura Mancini & Eugenia Panicara & Massimiliano Paolicelli, 2018. "The Italian healthcare system: the difficult balance between budget sustainability and the quality of services in Regions subject to Financial Recovery Plan," Questioni di Economia e Finanza (Occasional Papers) 427, Bank of Italy, Economic Research and International Relations Area.
    7. Cavalieri, Marina & Ferrante, Livio, 2016. "Does fiscal decentralization improve health outcomes? Evidence from infant mortality in Italy," Social Science & Medicine, Elsevier, vol. 164(C), pages 74-88.

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    More about this item

    Keywords

    fiscal decentralization; regional governments; healthcare policy; health inequalities;
    All these keywords.

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I1 - Health, Education, and Welfare - - Health
    • R50 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - Regional Government Analysis - - - General

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