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Bureaucratic institutional design: the case of the Italian NHS

Silvia Fedeli (), Leone Leonida () and Michele Santoni ()
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Silvia Fedeli: Sapienza - Università di Roma

Public Choice, 2018, vol. 177, issue 3, No 5, 265-285

Abstract: Abstract We propose a model where a regional government’s choice of the number of bureaucratic agencies operating in a region depends upon the degree of substitutability and complementarity of the bureaucratic services being demanded. We show that, if the government perceives the citizens’ demand as a demand for substitutable services, it will choose provision by two independent agencies. If the government perceives the citizens’ demand as a demand for complementary services, it will choose provision by a single consolidated agency. Exogenous shocks to the number of citizens amplify these incentives. Evidence from the Italian National Health Service (NHS) supports this hypothesis. Results show a positive effect of proxies of substitutable services on the number of regional local health authorities and a negative effect of proxies of complementary services. The major immigration amnesties, taken as shocks to the number of citizens entitled to the service, magnify these effects.

Keywords: Bureaucratic institutional design; Public local health authorities; Consolidation and decentralization of local health authorities; Italian NHS (search for similar items in EconPapers)
JEL-codes: D73 H75 I18 L32 (search for similar items in EconPapers)
Date: 2018
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DOI: 10.1007/s11127-018-0569-6

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