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Decentralisation in the health sector and responsibilities across levels of government: Impact on spending decisions and the budget

Author

Listed:
  • Chris James
  • Ivor Beazley
  • Caroline Penn
  • Leah Philips
  • Sean Dougherty
Abstract
This article sheds light on the role of subnational governments in health systems across OECD countries. The views in this article show a move away from traditional measures of decentralisation, such as the share of subnational government expenditure of total expenditure, to measures capturing a range of responsibilities in the health sector. The data comes from the 2017 OECD Survey on Performance Measurement Systems in the Health Sector and Responsibilities across Levels of Government. The results show that despite health representing a large sector of subnational government expenditure, central governments still have considerable decision-making power. This power applies to key policy-making and budgeting decisions.

Suggested Citation

  • Chris James & Ivor Beazley & Caroline Penn & Leah Philips & Sean Dougherty, 2019. "Decentralisation in the health sector and responsibilities across levels of government: Impact on spending decisions and the budget," OECD Journal on Budgeting, OECD Publishing, vol. 19(3).
    • Handle: RePEc:oec:govkaa:c2c2058c
    DOI: 10.1787/c2c2058c-en
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    File URL: https://doi.org/10.1787/c2c2058c-en
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    Citations

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    Cited by:

    1. Andreas P Kyriacou & Oriol Roca-Sagalés, 2024. "Fiscal Decentralization and Health Care Access and Quality: Evidence from Local Governments around the World," Publius: The Journal of Federalism, CSF Associates Inc., vol. 54(2), pages 313-338.
    2. Sean Dougherty & Luca Lorenzoni & Alberto Marino & Fabrice Murtin, 2022. "The impact of decentralisation on the performance of health care systems: a non-linear relationship," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(4), pages 705-715, June.

    More about this item

    Keywords

    Decentralisation; subnational; health system;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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