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The distributional impact of health public expenditure in Italian regions: what happens when cost-effectiveness and quality matter?

Laura Bianchini, Santino Piazza and Alberto Cassone ()
Additional contact information
Laura Bianchini: Department of Transportation
Santino Piazza: IRES Piemonte
Alberto Cassone: Universita’ del Piemonte Orientale A. Avogadro

Economia Politica: Journal of Analytical and Institutional Economics, 2017, vol. 34, issue 3, 445-469

Abstract: Abstract We evaluate the implications of in-kind health transfers on household income distribution in Italy, factoring in the quality of government-provided healthcare in different regions (which are responsible for health policy). The novelty of this approach is that we explicitly acknowledge differences in the value of in-kind transfers resulting from cross-regional variations in service quality. The aim of this paper is twofold. First we adopt a fiscal federalism approach to assess the distributional implications of adding health public expenditure to the disposable income of Italian households and we compare the distributional results across regions. We then take a yardstick competition approach to evaluate the distributional implications of accounting for the quality and efficiency of services. To analyze the distributional impact of health public expenditure, we show the difference of the Gini index between final income and disposable income for each region and the progressivity index (Kakwani index). The re-ranking effect and the average in-kind benefit rate (that is the ratio of total in-kind transfers to disposable income) are also computed. Our analysis provides convincing evidence that when health services are evaluated at production cost, in-kind benefits reduce overall inequality on the distribution of disposable income. However, this effect is seen to be lower when the yardstick competition approach is applied to account for quality and cost-effectiveness, and, more importantly, it shows a geographical pattern.

Keywords: Health policy; Distributional impact; In-kind transfers; Public expenditure and service quality (search for similar items in EconPapers)
JEL-codes: I14 I18 H51 H75 (search for similar items in EconPapers)
Date: 2017
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