This paper examines the determinants of regional public health expenditure in a decentralised health system. Unlike previous studies we take into account possible policy and political interactions among authorities, as well as unobserved heterogeneity. Our emprirical contribution lies in running a spatial panel specification using a dataset of all Spanish region states on aggregated and disaggregated health expenditures (pharmaceuticals, inpatient and primary care). Results are consistent with some degree of interdependence between neighboring regions in spending decisions. Empirical evidence of long term efficiency effects of health care decentralisation, suggests that a specific spatial-institutional design might improve the health system efficiency as well as regional cohesion. Political and scale effects are consistent with theoretical predictions.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Alexander F (1993) Viruses, clusters and clustering of childhood leukemia. Eur J Cancer 29:24–43
Anselin L (1988) Spatial econometrics: methods and models. Kluwer, Dordrecht
Arbia G (2006) Introductory spatial econometrics with applications to regional convergence. Springer, Berlin
Baicker K (2005) The spillover effects of state spending. J Public Econ 89:529–544
Baltagi BH, Song SH, Koh W (2003) Testing panel data regression models with spatial error correlation. J Econom 117:123–150
Besley T, Case A (1995) Incumbent's behavior: vote seeking, tax-setting and yardstick competition. Am Econ Rev 85:25–45
Brueckner JK (2000) Welfare reform and the race to the bottom: theory and evidence. South Econ J 66:505–525
Costa-Font J, Pons-Novell J (2007) Public health expenditure and spatial interactions in a decentralized national health system. Health Econ 16:291–306
Costa-Font J, Rico A (2006) Vertical competition in the Spanish National health System. Public Choice 128:477–498
Crivelli L, Filippini M, Mosca I (2006) Federalism and regional health expenditures: an empirical analysis of Swiss cantons. Health Econ 15:535–541
Davis P, Gribben B, Scott A, Lay-Yee R (2000) The supply hypothesis and medical practice variation in primary care: testing economic and clinical models of inter-practitioner variation. Soc Sci Med 50:407–418
Di Matteo L, Di Matteo R (1998) Evidence on the determinants of Canadian Provincial Government Health Expenditure 1965–1991. J Health Econ 17:211–228
Florax RJGM, Folmer H, Rey SJ (2003) Specification searches in spatial econometrics: the relevance of Hendry's methodology. Reg Sci Urban Econ 33:557–579
Gatrell AC, Whitelegg J (1993) Incidence of childhood cancer in Preston and South Ribble Research Report Environmental Epidemiology Research Unit, Lancaster University
Giannoni M, Hittris T (2002) The regional impact of health care expenditure: the case of Italy. Appl Econ 34:1829–1836
Henrekson M (1988) Swedish government growth: a disequilibrium analysis. In: Lybeck JA, Henrekson M (eds) Explaining the Growth of Government. North-Holland, Amsterdam
Hsiao C (2003) Analysis of panel data, econometric society monographs. Cambridge University Press, London
Hsiao CK (2000) Comparing the performance of two indices for spatial model selection: application to two mortality data. Stat Med 19:1915–1930
Lopez-Casasnovas G, Costa-Font J, Planas I (2005) Diversity and regional inequalities: assessing the outcomes of the Spanish ‘system of health care services’. Health Econ 14S:S221–S235
Lorant VT, Thomas I, Deilege I, Tonglet R (2001) Deprivation and mortality: the implications of spatial autocorrelation for health resources allocation. Soc Sci Med 53:1711–1719
McMillen DP (2003) Spatial autocorrelation or model misspecification? Int Reg Sci Rev 26:208–217
Moscone F, Knapp M (2005) Exploring the spatial pattern of mental health expenditure. J Mental Health Policy Econ 8:205–217
Moscone F, Knapp M, Tosetti E (2007a) Mental health expenditure in England: a spatial panel approach. J Health Econ 4:659–864
Moscone F, Tosetti E, Knapp M (2007b) SUR model with spatial effects: an application to mental health expenditure. Health Econ Lett 11(2):3–9
Navarro V, Muntaner C, Borrell C, Benach J, Quiroga A, Rodriguez-Sanz M, Verges N, Pasarin MI (2006) Politics and health outcomes. Lancet 368:1033–1037
Newhouse JP (1977) Medical care expenditure: a cross-national survey. J Hum Resour 12:115–125
Newhouse JP (1992) Medical care costs: how much welfare loss? J Econ Perspect 6:3–21
Okunade AA, Murthy VNR (2002) Technology as a major driver of health care costs: a cointegration analysis of the Newhouse conjecture. J Health Econ 21:147–159
Parkin D, McGuire A, Yule B (1987) Aggregate health care expenditures and national income: is health care a luxury good? J Health Econ 6:109–127
Revelli F (2002) Testing the tax mimicking versus expenditure spill-over hypotheses using English data. Appl Econ 34:1723–1731
Revelli F (2006) Performance rating and yardistick competition in social service provision. J Public Econ 90:459–475
Rico A, Costa-Font J (2006) Power rather than path? The dynamics of health care federalism in Spain. J Health Polit Policy Law 30:231–252
Skinner J, Wennberg JE (2000) Regional inequality in medicare spending. The key to medicare reform? Front Health Policy Res 3:89–96
Tavares J (2004) Does the rightorleft matter? Cabinets, credibility and adjustments.J Public Econ 88:2447–2468
Thouez JP, Emard JF, Beaupre M, Latreille J, Ghadirian P (1997) Space-time analysis of the incidence of cancer in certain sites of Quebec: 1984–1986 and 1989–1991. Can J Public Health 88:48–51
Zellner A (1962) An efficient method for estimating seemingly unrelated regressions and tests of aggregation bias. J Am Stat Assoc 58:977–992
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Physica-Verlag Heidelberg
About this chapter
Cite this chapter
Costa-Font, J., Moscone, F. (2009). The impact of decentralization and inter-territorial interactions on Spanish health expenditure. In: Arbia, G., Baltagi, B.H. (eds) Spatial Econometrics. Studies in Empirical Economics. Physica-Verlag HD. https://doi.org/10.1007/978-3-7908-2070-6_9
Download citation
DOI: https://doi.org/10.1007/978-3-7908-2070-6_9
Publisher Name: Physica-Verlag HD
Print ISBN: 978-3-7908-2069-0
Online ISBN: 978-3-7908-2070-6
eBook Packages: Business and EconomicsEconomics and Finance (R0)