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Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'

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Abstract
The consolidation of a universal health system coupled with a process of regional devolution characterise the institutional reforms of the National Health System (NHS) in Spain in the last two decades. However, scarce empirical evidence has been reported on the effects of both changes in health inputs, outputs and outcomes, both at the country and at the regional level. This paper examines the empirical evidence on regional diversity, efficiency and inequality of these changes in the Spanish NHS using cross-correlation, panel data and expenditure decomposition analysis. Results suggest that besides significant heterogeneity, once we take into account region-specific needs there is evidence of efficiency improvements whilst inequalities in inputs and outcomes, although more ‘visible’, do not appear to have increased in the last decade. Therefore, the devolution process in the Spanish Health System offers an interesting case for the experimentation of health reforms related to regional diversity but compatible with the nature of a public NHS, with no sizeable regional inequalitiest.

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  • Guillem López & Joan Costa-Font & Ivan Planas, 2004. "Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'," Economics Working Papers 745, Department of Economics and Business, Universitat Pompeu Fabra.
    • Handle: RePEc:upf:upfgen:745
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    Cited by:

    1. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Economics and Management, Springer, vol. 10(3), pages 219-237, September.
    2. Joan Costa-Font & Ana Rico, 2006. "Devolution and the Interregional Inequalities in Health and Healthcare in Spain," Regional Studies, Taylor & Francis Journals, vol. 40(8), pages 875-887.
    3. Joan Costa-Font & Francesco Moscone, 2009. "The impact of decentralization and inter-territorial interactions on Spanish health expenditure," Studies in Empirical Economics, in: Giuseppe Arbia & Badi H. Baltagi (ed.), Spatial Econometrics, pages 167-184, Springer.
    4. Guillem Lopez‐Casasnovas & Joan Costa‐Font & Ivan Planas, 2005. "Diversity and regional inequalities in the Spanish ‘system of health care services’," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 221-235, September.
    5. Joan Costa-Font & Ana Rico, 2006. "Vertical Competition in the Spanish National Health System (NHS)," Public Choice, Springer, vol. 128(3), pages 477-498, September.
    6. Sergi Jimenez & Natalia Jorgensen & José María Labeaga, 2008. "Immigration and the Demand for Health in Spain," Working Papers 2008-38, FEDEA.
    7. Joan Costa‐Font & Jordi Pons‐Novell, 2007. "Public health expenditure and spatial interactions in a decentralized national health system," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 291-306, March.
    8. Joan Costa Font & Joan Gil Trasfi, 2007. "Generational Effects on Adult Height in Contemporary Spain: Exploring Gender and Individual Heterogeneity," Working Papers in Economics 169, Universitat de Barcelona. Espai de Recerca en Economia.
    9. Ms. Izabela Karpowicz, 2012. "Narrowing Vertical Fiscal Imbalances in Four European Countries," IMF Working Papers 2012/091, International Monetary Fund.
    10. Joan Costa & Jaume Puig, 2004. "Regulatory ambivalence and the limitations of pharmaceutical policy in Spain," Working Papers, Research Center on Health and Economics 762, Department of Economics and Business, Universitat Pompeu Fabra.
    11. Costa-Font, Joan & Gil, Joan, 2008. "Generational effects and gender height dimorphism in contemporary Spain," Economics & Human Biology, Elsevier, vol. 6(1), pages 1-18, March.

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    More about this item

    Keywords

    Health expenditure; devolution; National Health System; regional inequalities; Spain;
    All these keywords.

    JEL classification:

    • H7 - Public Economics - - State and Local Government; Intergovernmental Relations
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • H31 - Public Economics - - Fiscal Policies and Behavior of Economic Agents - - - Household

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