Library Header Image
LSE Research Online LSE Library Services

Does devolution influence the choice and quality of public (vs private) health care?

Costa-Font, Joan ORCID: 0000-0001-7174-7919 and Ferrer-i-Carbonell, Ada (2022) Does devolution influence the choice and quality of public (vs private) health care? Journal of Economic Behavior & Organization, 202. 632 - 653. ISSN 0167-2681

[img] Text (1-s2.0-S0167268122002967-main) - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (3MB)

Identification Number: 10.1016/j.jebo.2022.08.022


Government decentralisation also called ‘government devolution’ (GD) can provide an alternative to the ‘build in’ accountability mechanism of markets by influencing both the choice as well as the perceived quality of public versus private health care. To test this hypothesis, this paper exploits the gradual decentralisation of the political stewardship of the Spanish National Health System (NHS) using a difference-in-differences design. We find that GD (abandoning centralised governance) increases the choice and quality of (measured by the preference for, perceptions of, and satisfaction with) public health care (NHS) compared to private health care. Consistently, we also find that the GD reduces the uptake of private health insurance among higher income and education groups. These effects are mainly driven by improvements in health care quality as well as policy innovation and diffusion.

Item Type: Article
Official URL:
Additional Information: © 2022 The Author(s).
Divisions: Health Policy
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited: 16 Aug 2022 10:03
Last Modified: 18 Apr 2024 01:39

Actions (login required)

View Item View Item


Downloads per month over past year

View more statistics