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Public Choice

, Volume 128, Issue 3–4, pp 477–498 | Cite as

Vertical Competition in the Spanish National Health System (NHS)

  • Joan Costa-FontEmail author
  • Ana Rico
Article

Abstract

In unitary states, competitive decentralisation structures can take place by increasing the visibility of politically accountable jurisdictions in certain policy responsibilities such as health care. Drawing from the Spanish decentralisation process we examine the mechanisms (and determinants) of vertical competition in the development of health policies in the Spanish National Health System. The Spanish example provides qualitative evidence of vertical competition that assimilates government outcomes of unitary states to that of federal structures. The Spanish experience indicates that the specific vertical competition mechanisms in place until 2002 are likely to be responsible for significant policy innovation and welfare state development.

Keywords

Unitary State Policy Innovation National Health System Basque Country Autonomous Community 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Besley, T., & Case, A. (1995). ‘Incumbent Behaviour, Vote Seeking, Tax Setting and Yardstick Competition,’ American Economic Review, 85, 25–45.Google Scholar
  2. Besley, T., & Coate, S. (1999). Centralised vs Decentralised Provision of Local Public Goods: a Political Economy Analysis, NBER Working Paper, Cambridge.Google Scholar
  3. Besley, T., & Smart, M. (2003). Does Tax Competition Raise Voter Welfare? C.E.P.R. Discussion Papers, 3031.Google Scholar
  4. Boyne, G., & Powell, M. (1993). Territorial Justice and Thatcherism, Environment and Planning, C, 11, 35–53.Google Scholar
  5. Brenan, G., & Buchanan, J. (1980). The Power to Tax (Cambridge: Cambridge University Press).Google Scholar
  6. Breton, A. (1996). Competitive Governments. An Economic Theory of Politics and Public Finance (Cambridge: Cambridge University Press).Google Scholar
  7. Breton, A., & Fraschini, A. (2003). Vertical competition in unitary states: the case of Italy. Public Choice, 114, 57–77.CrossRefGoogle Scholar
  8. Brueckner, J. K. (2000). Welfare Reform and Race to the Bottom: Theory and Evidence. Southern Economic Journal, 66, 505–525.CrossRefGoogle Scholar
  9. Costa-Font, J., Rodriguet-Oleggia, E. & Luna-Pla, D. (2003). Political competition and peribarrel politics in the allocation of public investment in Mexico. Public choice, 116, 195–204.Google Scholar
  10. Congleton, R. D., Kyriacou, A., & Ani Bacaria, J. (2003). A Theory of Menu Federalism: Decentralization by Political Agreement. Constitutional Political Economy, 14, 167– 190.CrossRefGoogle Scholar
  11. Frey, B. S., & Eichenberger, R. (1996). ‘Competitive Governments for Europe,’ International Review of Law and Economics, 16, 315–27.CrossRefGoogle Scholar
  12. George, A. (2003). Accountability in Health Services. Transforming Relationships and Contexts.Harvard Center for Population and Development Studies, Working Paper Series, vol. 13 1 (February).Google Scholar
  13. Hausken, K., Martin, C. W., & Plümper, T. (2004). Government spending and taxation in Democracies and autocracies. Constitutional Political Economy, 15, 239– 259.CrossRefGoogle Scholar
  14. Josselin, J.-M., & Marciano, A. (2004). Federalism and Conflicts over Principalship. Some Insights into the American Constitutional History. Constitutional Political Economy, 15: 281–304CrossRefGoogle Scholar
  15. Kenyon, D. A., & Kincaid, J. (eds.) Competition among States and Local Governments (Washington: Urban Institute).Google Scholar
  16. Kneebone, R. D. (1992). ‘Centralisation and the Size of Government in Canada,’ Applied Economics, vol. 24, pp. 1293–1300.Google Scholar
  17. Leeson, H. (2002). Constitutional Jurisdiction over Health and Health care in Canada, Commission on the Future of Health Care in Canada, Discussion Paper, no. 12Google Scholar
  18. López Casasnovas, G. (1998). ‘Financiación autonómica y gasto sanitario público en España’ Papeles de Economía Española, 76, 2–14.Google Scholar
  19. López Casasnovas, G. (2002). The Development of New Regional Health Policies and the Need for Coordination: The Case of the Pharmaceutical Market, XXII Jornadas de Economía de la Salud (Pamplona).Google Scholar
  20. 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 Economics 14(5); 5221–5235Google Scholar
  21. Lovering, J. (1999). ‘Theory Led by Policy: The Inadequacies of the New Regionalism,’ International Journal of Urban and Regional Research, 23, 379–95.CrossRefGoogle Scholar
  22. Oates, W. (1977). The Political Economy of Federalism (Lexington Massachusetts: Lexington Books).Google Scholar
  23. OECD (1997). Managing Across Levels Of Government, Spain. Organization of Economic Cooperation and Development [http://www.oecd.org/dataoecd/9/33/1902255.pdf, visited April 2004]
  24. Redwood, J. (1999). The Death of Britain (Basingstoke: Macmillan).Google Scholar
  25. Rico, A., & Costa-Font, J. (2005). Power Rather than Path? The Dynamics of Institutional Change under Health Care Federalism. Journal of Health Politics, Policy & Law 30(i); 231–252.Google Scholar
  26. Rico, A. (2000). ‘Health Policy under Asymmetric Federalism: Twenty Years of Regional Devolution in Spain,’ Eurohealth, 6(3) 28–9.Google Scholar
  27. Rico, A., Fraile, M., & González, P. (1998). ‘Regional Decentralization of Health Care Policy in Spain: Social Capital does not Tell the Whole Story,’ West European Politics, 21(4) 180–99.Google Scholar
  28. Salmon, P. (1987). Decentralisation as an incentive scheme. Oxford Review of Economic Policy, 3, 24–43.Google Scholar
  29. Salmon, P. (2000). ‘Vertical Competition in a Unitary State,’ in G. Galeotti, P. Salomon, & R. Wintrobe (Eds.) Competition and Structure: the Political Economy of Collective Decisions: Essays in Honour of Albert Breton (Cambridge: Cambridge University Press).Google Scholar
  30. Sawicky, M. B. (1999). ‘The new American devolution: Problems and Prospects,’ in M.B.Sawicky (eds) The End of Welfare? Consequences of Federal Devolution for the Nation (Economic Policy Institute, USA).Google Scholar
  31. Stein, E (1997). Fiscal Decentralization and Government Size in Latin America. In Fukasaku, K. and Hausmann, R. (Eds). Democracy, Descentralisation and Deficits in Latin America, IDB-OECD.Google Scholar
  32. Tiebout, C. M. (1956). A Pure Theory of Local Expenditures,’ Journal of Political Economy, 64, 416–24.CrossRefGoogle Scholar
  33. Walker, J. L. (1969). The Diffusion of innovations among American States. American Political Science Review, 77, 880–99.Google Scholar
  34. Weisbrod, B. A. (1977). The Voluntary Non-Profit Sector: Economic Theory and Public Policy (Lexington: Lexington Press).Google Scholar
  35. Wittman, R. (1989). Why democracies produce efficient results?. Journal of Political Economy, 97, 1395–1424.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.London School of EconomicsLondonUK
  2. 2.Erasmus UniversityRotterdamThe Netherlands
  3. 3.Departament de Teoria EconòmicaUniversitat de BarcelonaCataloniaSpain
  4. 4.University of OsloOsloNorway

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