Health Expenditure Decentralization and Health Outcomes: The Importance of Governance

Ryota Nakatani, Qianqian Zhang and Isaura Garcia Valdes

Publius: The Journal of Federalism, 2024, vol. 54, issue 1, 59-87

Abstract: Does health expenditure decentralization improve a nation’s health? Should countries care about governance quality when they decentralize healthcare spending to local governments? We answer these questions using cross-country data comprising fifty countries from 1996 to 2018. We find that health spending decentralization worsens health outcomes, which are offset by better governance of government. We calibrate the maximum feasible degree of health expenditure decentralization to have positive effects on health outcomes for a given percentile distribution of governance quality. Countries should be mindful of this negative consequence of health spending decentralization and should ensure that the quality of their governance exceeds a certain threshold to offset this negative externality. We also find that vertical fiscal imbalance is negatively associated with health outcomes, underscoring the role of revenue decentralization in improving the fiscal discipline of local governments by avoiding moral hazard caused by soft budget constraints and the common pool problem.

Date: 2024
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (4)

Downloads: (external link)
http://hdl.handle.net/10.1093/publius/pjad031 (application/pdf)
Access to full text is restricted to subscribers.

Related works:
Working Paper: Health Expenditure Decentralization and Health Outcomes: The Importance of Governance (2023)
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:oup:publus:v:54:y:2024:i:1:p:59-87.

Ordering information: This journal article can be ordered from
https://academic.oup.com/journals

Access Statistics for this article

Publius: The Journal of Federalism is currently edited by Paul Nolette and Philip Rocco

More articles in Publius: The Journal of Federalism from CSF Associates Inc. Oxford University Press, Great Clarendon Street, Oxford OX2 6DP, UK.
Bibliographic data for series maintained by Oxford University Press ().