Fiscal federalism and European health system decentralization: a perspective

Joan Costa-i-Font

LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library

Abstract: How does fiscal decentralisation affect the development of a health system? Evidence from health care decentralisation in Europe can offer some insights to the question above. This paper addresses the effects of health care decentralisation in Europe, and reviews some of the key questions on the design of a health system. We argue that contrary to old mobility argument, the effects of health care decentralisation result from tighter political agency, which generally stands as an alternative to health care privatisation. However, whether efficiency improves after a process of decentralisation depends heavily on the incentives fiscal design exerts on cost –containment, inter-jurisdictional competition, policy innovation and diffusion. Experiences of health care decentralisation highlight important concerns associated with vertical imbalances and limited horizontal imbalances. Finally, health care decentralisation can give rise to a new regional political cycle where citizens can reward or penalise the performance of health policy.

Keywords: health systems decentralisation; fiscal federalism; health care; political agency (search for similar items in EconPapers)
JEL-codes: H51 I18 (search for similar items in EconPapers)
Pages: 29 pages
Date: 2012-12
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (3)

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http://eprints.lse.ac.uk/47881/ Open access version. (application/pdf)

Related works:
Working Paper: Fiscal Federalism and European Health System Decentralization: A Perspective (2012)
Working Paper: Fiscal Federalism and European Health System Decentralization: A Perspective (2012)
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Persistent link: https://EconPapers.repec.org/RePEc:ehl:lserod:47881

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