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Vertical Competition in the Spanish National Health System (NHS)

Public Choice volume 128, pages 477–498 (2006)Cite this 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.

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Authors and Affiliations

  1. London School of Economics, London, UK

    Joan Costa-Font

  2. Erasmus University, Rotterdam, The Netherlands

    Ana Rico

  3. Departament de Teoria Econòmica, Universitat de Barcelona, Catalonia, Spain

    Joan Costa-Font

  4. University of Oslo, Oslo, Norway

    Ana Rico

Authors
  1. Joan Costa-Font
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  2. Ana Rico
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Correspondence to Joan Costa-Font.

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Costa-Font, J., Rico, A. Vertical Competition in the Spanish National Health System (NHS). Public Choice 128, 477–498 (2006). https://doi.org/10.1007/s11127-005-9011-y

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  • DOI: https://doi.org/10.1007/s11127-005-9011-y

Keywords

  • Unitary State
  • Policy Innovation
  • National Health System
  • Basque Country
  • Autonomous Community