Efficiency and equity consequences of decentralizationin health: an economic perspective

• Autor(a) principal: Alves, Joana
• Data de Publicação: 2013
• Outros Autores: Peralta, Susana, Perelman, Julian
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10362/19796
• topic: Decentralization; Efficiency; Equity; Health Economics; Incentives; Descentralização; Eficiência; Equidade; Economia da saúde; Incentivos

A B S T R A C T – Over the recent years, decentralization has been adopted in many health systems. Thequestion however remains of whether local actors do better than the central government.We summarize the main insights from economic theory on the impact of decentraliza-tion and its empirical validation. Theory suggests that the decision to decentralize resultsfrom a trade-off between its advantages (like its capacity to cater to local tastes) and costs(like inter-regional spillovers). Empirical contributions point that decentralization results inbetter health outcomes and higher expenditures, resulting in ambiguous consequences onefficiency; equity consequences are controversial and address the relevance of redistributionmechanisms.