Abstract
Spain is a country of paramount importance for healthcare decentralization scholars given its deep process of devolution of health and education to region states. Such a process dates back to a strategy of democratization of a centralistic state as well as a modernization mechanism to improvising the efficiency in the delivery of public services. However, there is an unintended agenda. More precisely, by creating different regional health services a health system takes advantage of welfare gains associated with interjurisdictional competition and innovation and at the same time encourages local healthcare preference matching. These can take place if citizens exert the so-called “vote with one’s feet” exit option. Or, under restricted mobility but visible political and fiscal accountability it can open up political mechanisms of the political action to exercise voice, and more generally electorally reward regional incumbents benchmarked against those of similar jurisdictions (Besley and Case 1995; Revelli 2002). As discussed in Chapter 2 on fiscal federalism, both mechanisms are important to incentivize incumbents to improve the performance of public services, and are generally absent in centralized health system
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Banting, K. (1987). The Welfare State and Canadian Federalism. McGill-Queen’s University Press, Kingston.
Besley, T. and Case, A. (1995). Incumbent behaviour: vote-seeking, tax-Setting, and yardstick competition. The American Economic Review, 85 (1), pp. 25–45.
Costa-Font, Joan (2005). Inequalities in self-reported health within Spanish regional health services: devolution re-examined? International Journal of Health Planning and Management, 20 (1), pp. 41–52.
Costa-Font, Joan (2010a). Devolution, diversity and welfare reform: long-term care in the “Latin Rim”. Social Policy & Administration, 44 (4), pp. 481–494.
Costa-Font, Joan (2010b). Does devolution lead to regional inequalities in welfare activity? Environment and Planning C: Government and Policy, 28 (3), pp. 435–449.
Costa-Font, Joan and Moscone, Francesco (2008). The impact of decentralization and inter-territorial interactions on Spanish health expenditure. Empirical Economics, 34(1), pp. 167–184.
Costa-Font, Joan and Pons-Novell, J. (2007). Public health expenditure and spatial interactions in a decentralized national health system. Health Economics, 16(3), pp. 291–306.
Costa-Font, Joan and Puig-Junoy, Jaume (2007). Institutional change, innovation and regulation failure: evidence from the Spanish drug market. Policy and Politics, 35(4), pp. 701–718.
Costa-Font, Joan and Rico, A. (2006a) Vertical competition in the Spanish National Health System (NHS). Public Choice, 128 (3–4), pp. 477–498.
Costa-Font, Joan and Rico, A. (2006b) Devolution and the interregional inequalities in health and healthcare in Spain. Regional Studies, 40 (8), pp. 1–13.
Lopez-Casasnovas, G., Costa-Font, J. and Planas, I. (2005). Diversity and regional inequalities: assessing the outcomes of the Spanish “system of health care services”, Health Economics 14 (S), pp. S221–S235.
Powell, M. and Boyne, G. (2001). The spatial strategy for equality and the spatial division of welfare. Social Policy & Administration, 35, pp. 181–194.
Revelli, F. (2002). Testing the tax mimicking versus expenditure spillover hypothesis using English data. Applied Economics, 14, pp. 1723–1731
Rico, A. and Costa-Font, J. (2005). Power rather than path? The dynamics of institutional change under health care federalism. Journal of Health Politics, Policy & Law, 30(1), pp. 231–252.
Salmon, P. (1987). Decentralisation as an incentive scheme. Oxford Review of Economic Policy, 3, pp. 24–43.
Tiebout, C.M. (1956). A pure theory of local expenditures. Journal of Political Economy, 64, pp. 416–424.
Editor information
Editors and Affiliations
Copyright information
© 2013 Joan Costa-Font and Scott L. Greer
About this chapter
Cite this chapter
Costa-Font, J. (2013). Decentralization and the Spanish Health System: Soft Budget Constraint Modernization?. In: Costa-Font, J., Greer, S.L. (eds) Federalism and Decentralization in European Health and Social Care. Palgrave Macmillan, London. https://doi.org/10.1057/9781137291875_4
Download citation
DOI: https://doi.org/10.1057/9781137291875_4
Publisher Name: Palgrave Macmillan, London
Print ISBN: 978-1-349-33040-9
Online ISBN: 978-1-137-29187-5
eBook Packages: Palgrave Political & Intern. Studies CollectionPolitical Science and International Studies (R0)