Regional Institutional Quality and Territorial Equity in LTC Provision

Marenzi, A.;, Rizzi, D.;, Zanette, M.; and Zantomio, F.;

Health, Econometrics and Data Group (HEDG) Working Papers from HEDG, c/o Department of Economics, University of York

Abstract: We show how regional governments affect the appropriate – in terms of territorial equity - assignment of a national LTC benefit. We analyse a three-layers setting, where eligibility criteria are defined by the central government (which bears the fiscal cost of transfers) but the assignment decision is taken by regional medical commissions, while applications are activated by individual potential beneficiaries. Combining administrative and survey data, and accounting for regional variation in eligibility prevalence, we document large territorial disparities in needadjusted benefit assignment. We investigate the determinants of such disparities both in terms of individuals’ differential propensity to claim, and of regional discretionary behaviour, as shaped by the underlying quality of regional institutions. Regional discretion appears to play a major role, with local institutional quality accounting for about one fifth of explained variation in needadjusted benefit coverage. Lower regional institutional quality results in more opportunistic benefit adjudication decisions, although the relationship is attenuated in highly deprived areas.

Keywords: territorial equity; regional discretion; multi-level government; institutional quality; long-term care; benefit targeting (search for similar items in EconPapers)
JEL-codes: C13 H11 H53 H75 J14 (search for similar items in EconPapers)
Date: 2022-10
New Economics Papers: this item is included in nep-eur, nep-geo and nep-ure
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Persistent link: https://EconPapers.repec.org/RePEc:yor:hectdg:22/27

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