The stimulative effect of an unconditional block grant on the decentralized provision of care

Mark Kattenberg () and Wouter Vermeulen
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Mark Kattenberg: CPB Netherlands Bureau for Economic Policy Analysis
Wouter Vermeulen: CPB Netherlands Bureau for Economic Policy Analysis

International Tax and Public Finance, 2018, vol. 25, issue 1, No 5, 166-199

Abstract: Abstract Understanding the impact of central government grants on decentralized healthcare provision is of crucial importance for the design of grant systems, yet empirical evidence on the prevalence of flypaper effects in this domain is rare. We study the decentralization of home care in the Netherlands and exploit the gradual introduction of formula-based equalization to identify the effect of exogenous changes in an unconditional block grant on local expenditure and utilization. A one euro increase in central government grants raises local expenditure by twenty to fifty cents. Adjustments occur through the number of hours as well as through substitution between basic and more advanced types of assistance. These findings suggest that conditioning of grants is not required for the central government to retain a moderate degree of control over the decentralized provision of care.

Keywords: Intergovernmental transfers; Flypaper effect; Decentralization of health care (search for similar items in EconPapers)
JEL-codes: H42 H51 H71 H75 (search for similar items in EconPapers)
Date: 2018
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Citations: View citations in EconPapers (4)

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DOI: 10.1007/s10797-017-9442-7

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