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The impact of decentralisation on the performance of health care systems: a non-linear relationship

Dougherty, Sean, Lorenzoni, Luca, Marino, Alberto ORCID: 0000-0003-1588-8746 and Murtin, Fabrice (2022) The impact of decentralisation on the performance of health care systems: a non-linear relationship. European Journal of Health Economics, 23 (4). 705 - 715. ISSN 1618-7598

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Identification Number: 10.1007/s10198-021-01390-1


This paper examines the role of institutions—notably the degree of administrative decentralisation across levels of government—in health care decision-making and health spending as well as life expectancy. The empirical analysis builds on a new methodology to analyse health sector performance. In particular, the present analysis examines the impact of centralisation versus decentralisation of responsibilities across levels of government, making use of newly collected data on governance and expenditure assignment, as well as non-linear empirical specifications. An interlocking U-shaped relationship is found with respect to expenditure and life expectancy. Under moderate decentralisation, public spending in health care is lower, while life expectancy is higher, compared with more centralised systems; however, in highly decentralised systems, public spending is higher and life expectancy is lower. This finding of a “fish-shaped” relationship for decentralisation and outcomes also helps to understand recent reforms of OECD health systems, which have often reverted towards more moderate degrees of administrative decentralisation.

Item Type: Article
Official URL:
Additional Information: © 2021 The Authors, under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Divisions: Health Policy
Subjects: R Medicine > RA Public aspects of medicine
JEL classification: H - Public Economics > H7 - State and Local Government; Intergovernmental Relations > H75 - State and Local Government: Health, Education, and Welfare
I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health
Date Deposited: 14 Mar 2022 11:09
Last Modified: 19 Jul 2024 23:39

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