An Evaluation of the 1997 Expenditure Decentralization Reform in Mexico

Abstract

This article studies the Mexican state-level impact on health outcomes of the decentralization of health funding and responsibilities that took place in 1997. Since the reform took place simultaneously in all states, we focus on a difference in difference estimation of whether those states that received more funds achieved better health outcomes after health services decentralization. According to our results, those states that received more funds did not boost the advances in health outcomes already achieved under the centralized health sector regime. There are two main possible explanations for these results. First, the allocation among states of the earmarked fund that was created as a result of the reform failed to take into account statespecific health needs. Second, the decentralization reform was not enough since it did not concede more tax autonomy to states and no other

Does Decentralization Improve Health System Performance and Outcomes in Low‐ and Middle‐Income Countries? A Systematic Review of Evidence From Quantitative Studies

“…More than half of the studies reported beneficial effects of decentralization in reducing infant and postneonatal mortality . Two studies did not find significant associations . Interestingly, 2 studies from Brazil and another 2 studies from China reported contradicting results between them.…”

“…Table reports the characteristics of the articles selected for review. Sixteen different studies were identified, with the earliest one published in 2003 and the most recent one published in 2016 . The selected studies were situated in Latin America ( n = 8), Asia ( n = 5), Africa ( n = 2), and multiple countries ( n = 1).…”

“…The impact of decentralization on health outcomes seemed to show consistently beneficial effects. There were 7 studies whose outcome variables were classified in the health outcomes domain . More than half of the studies reported beneficial effects of decentralization in reducing infant and postneonatal mortality .…”

“…Table presents the summary of quality assessment of studies being reviewed (see Online Appendix Table A for the complete results of quality assessment). Only 10 studies were considered to have relatively low risks of bias . These studies showed mixed results: 3 studies showed beneficial effects, 3 studies showed mixed effects, 2 studies showed harmful effects, and 2 studies showed an insignificant effect of decentralization …”

“…These studies showed mixed findings. One study focused on the effects of decentralization on health system inputs, 6 studies focused on health system performance, and 4 studies focused on health outcomes . In terms of the effects of decentralization on health system performance, only 1 study showed beneficial effects, while the rest of the studies showed mixed, harmful, or insignificant effects.…”