Comparative European Experience and the Decentralization Health Challenge
DOI:
https://doi.org/10.25115/eea.v32i2.3234Keywords:
Decentralization, Health Expenditure, Income, Health Outcomes, European Union.Abstract
This paper analyzes the main characteristics of European health care decentralization models with special attention to the determinants of health outcomes and expenditures and proposes using panel data models, and data from OECD Health Data, an econometric model explaining their behaviour and evolution. The results show that income is the most important factor in explaining the volume of health expenditure both statically and dynamically, while other factors of demand and supply and the degree of decentralization or type of health system, despite also influence are less important. Instead, in health outcomes fiscal decentralization has a more mixed against other factors.
Downloads
References
ARELLANO, M.; BOVER, O. (1995). “Another look at the instrumental variable estimation of error-components models” en Journal of Econometrics, 68(1), pp.29-51.
ATELLA, V.; MARINI; G. (2004a). “Is health care expenditure really a luxury good? Reassessment and new evidence based on OECD data”. Working Paper, http://papers.ssrn.com/abstract=383004.
ATELLA, V.; MARINI, G. (2004b). “The determinants of health care expenditure: a never ending story?”. Working Paper, http://papers.ssrn.com/abstract=607162.
BAC, C.; LE PEN, Y. (2002). “An international comparison of health expenditure determinants”. 10th International Conferences on Panel Data, Berlin, July 5-6.
BALTAGI, B.H. (2010) Econometric analysis of panel data. 4ª ed. Chichester: Wiley, 351p.
BANTING, K.G.; CORBETT, S. (2002). Health Policy and Federalism. A Comparative perspective on multi-level governance. McGill-Queen´s University Press, Kingston.
BARROS, P.P. (1998). “The black-box of health care expenditure growth determinants”. Health Economics, 7, pp. 533-544.
BLAZQUEZ, C., GONZALEZ, N., MORENO, P. (2013). “Pharmaceutical expenditure as a determinant of health outcomes in EU countries”. Estudios de Economía Aplicada, 31-2, pp. 379-396
BLUNDELL R.; BOND S. (1998). “Initial conditions and moment restrictions in dynamic panel data models”, Journal of Econometrics, 87(1), pp.115-43.
BROWN, M.C. (1987). “Caring for profit: economic dimensions of Canada’s health industry”. Fraser Institute, Vancouver.
CABASES-HITA, J.M. (2006). La financiación del gasto sanitario desde la perspectiva de la experiencia comparada. Bilbao: Fundación BBVA; 2006. 400p.
CABASES-HITA, J.M. (2010). La financiación del gasto sanitario en España. Valoración del sistema de financiación, medida de la necesidad relativa y equidad. Fundación BBVA; 2010. Informe Economía y Sociedad.
CANTARERO, D. (2006). “Determinantes del gasto sanitario: un análisis empírico para el caso europeo”, Estudios de Economía Española, 228, FEDEA, Madrid.
CANTARERO, D.; PASCUAL, M. (2008). “Analysing the impact of fiscal decentralization on health outcomes: empirical evidence from Spain”, Applied Economic Letters, (15), pp.109-111.
COSTA-FONT, J.; MOSCONE, F. (2008). “The impact of decentralization and interterritorial interactions on Spanish health expenditure”, Empirical Economics, 34(1), pp.167-184.
COSTA-FONT, J. (2012). “Fiscal Federalism and European Health System Decentralization: A Perspective”, LEQS, Paper No. 55/2012.
DI MATTEO, L. (2000). “The determinants of the public-private mix in Canadian health care expenditures: 1975-1996”. Health Policy, 52, pp. 87-112.
DI MATTEO, L. (2003). “The income elasticity of health care spending: a comparison of parametric and non-parametric approaches”. European Journal of Health Economics, 4, pp. 20-29.
GBESEMETE, K.P.; GERDTHAM, U.-G. (1992). “Determinants of Health Care Expenditure in Africa: A Cross-Sectional Study”. Word Development, 20, pp. 303-308.
GETZEN, T.E. (2001). “Aggregation and the measurement of health care costs”. Manuscript.
GERDTHAM, U.G.; JONSSON, B.; MACFARLAN, M.; OXLEY, H. (1998). The determinants of health expenditure in the OECD countries. En ZWEIFEL, P. (ed.): Health, The Medical Profesión and Regulation, Kluwer Academic Publishers, Dordrecht.
GERDTHAM, U.G.; JONSSON, B. (2000). “International comparisons of health expenditure: theory, data and econometric analysis”. En CULYER, A.J, NEWHOUSE, J.P. (eds.): Handbook of health economics, Vol. 1, Elsevier, Amsterdam.
GREENE WH. (2011). Econometric Analysis. 7ª ed. New Jersey: Pearson Education.
HABIBI, N.; HUANG, C.; MIRANDA, D.; MURILLO, V.; RANIS, G.; SARKAR, M. (2003). “Decentralization and Human Development in Argentina”, Journal of Human Development, 4(1).
HENDERSON, J.W. (2002). Health economics and policy. South-Western, 2nd edn, Thomson Learning, Cincinnati.
HAUSMAN, J.A. (1978). “Specification Tests in Econometrics” en Econometrica, 46, pp. 1013-1029.
JIMÉNEZ-RUBIO, D.; CANTARERO-PRIETO, D.; PASCUAL-SÁEZ, M. (2010). “Is fiscal decentralization good for you health? Evidence from a panel OECD countries”. XVIII Encuentro de Economía Pública 2011.
JIMÉNEZ-RUBIO, D. (2011). “The impact of decentralization of health services on health outcomes: evidence from Canada”. Applied Economics, 43(26), pp. 3907-3917.
JIMENEZ, D.; SMITH, P. (2005). “Decentralisation of health care and its impact on health outcomes”. Discussion Papers in Economics, Nº. 2005/10, University of York.
KANAVOS, P.; MOSSIALOS, E. (1996). “The methodology of international comparisons of health care expenditures: any lessons for health policy?” LSE Health Discussion Paper, No. 3, London.
KLEIMAN, E. (1974). The determinants of national outlay on Health. Macmillan, London.
LEU, R.E. (1986). “The public-private mix and international health care costs”. En CULYER, A.J., JONSSON, B. (Eds.): Public and Private health services, Basil Blackwell, Oxford, p. 41-63.
MAHAL, A.; SRIVASTAVA, V.; SANAN, D. (2000). “Decentralization and its impact on public service provision on health and education sectors: the case of India”, En: Dethier J (Ed.), Governance, Decentralization and Reform in China, India and Russia, Kluwer Academic Publishers and ZEF, London, p.77.
NAVARRO, J.L., HERNANDEZ, E. (2006). “Health technologies assessment: analysing the role of uncertainty”. Estudios de Economía Aplicada, 24-3, pp. 731-754.
NEWHOUSE, J.P. (1977). Medical care expenditure: a cross-national survey. Journal of Human Resources, 12, pp. 115-125.
OECD: OECD Health Data File.
PARKIN, D.; MCGUIRE, A.; YULE, B. (1987). “Aggregate health care expenditures and national income”. Journal of Health Economics, 6, pp. 109-127.
REINHARDT, U.E.; HUSSEY, P.S.; ANDERSON, G.F. (2002). “Cross National Comparisons of Health Care Systems using OECD data 1999”. Health Affairs, May/June, pp. 169-182.
ROBALINO, D. A.; PICAZO, O. F.; VOETBERG, A. (2001). “Does fiscal decentralization improve health outcomes? Evidence from a cross-country analysis”, Washington DC: World Bank, Policy Research Working Paper, 2565.
SEN, A. (2005): “Is health care a luxury? New evidence from OECD Data”. International Journal of Health Care Finance and Economics, 5, pp. 147-164.
URBANOS, R. (2004). “Tendencias internacionales en la financiación del gasto sanitario”. Papeles de Trabajo del Instituto de Estudios Fiscales, 19.
WENDT, C. (2009). “Mapping European healthcare systems: a comparative analysis of financing, service provision and access to healthcare”, Journal of European Social Policy, 19, pp. 432-445.
WOOLDRIDGE, J.M. (2010). Econometric analysis of cross section and panel data. 2ª ed. London: The MIT Press, 1064 p.
