Bailing out expectations and public health expenditure

Bordignon, Massimo; Turati, Gilberto

doi:10.1016/j.jhealeco.2008.12.008

Cited by 141 publications

(91 citation statements)

References 22 publications

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“…The main aims of the devolution reforms have been two-fold: to increase efficiency and to improve the financial responsiveness of decentralized authorities [2,6,7]. However, during the early years of the 21st century, a re-centralization process in European health systems has been observed, even if this trend has been limited only to certain functions specifically related to political and fiscal competences, while legislative powers over health sys- tem organization have remained at the regional level.…”

Section: Introductionmentioning

confidence: 99%

Health decentralization at a dead-end: towards new recovery plans for Italian hospitals

Mauro

Maresso²,

Guglielmo

2017

Health Policy

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a b s t r a c tThe recent introduction by the central government of recovery plans (RPs) for Italian hospitals provides useful insights into the recentralization tendencies that are being experienced within the country's decentralized, regional health system. The measure also contributes evidence to the debate on whether there is a long-term structural shift in national health strategy towards more centralized stewardship. The hospital RPs aim to improve the clinical, financial and managerial performance of public-hospitals, teaching-hospitals and research-hospitals through monitoring trends in individual hospitals' expenditure and tackling improvements in clinical care. As such they represent the central governments recognition of the weaknesses of the decentralization process in the health sector. The opponents of the reform argue that financial stability will be restored mainly through across-the-board reductions in hospital expenditure, personnel layoffs and closing of wards, with considerable negative effects on the most vulnerable groups of patients. While hospital RPs are comprehensive and complex, unresolved issues remain as to whether hospitals have the necessary managerial skills for the development of effective and achievable plans. Without also devising an overall plan to tackle the long-standing managerial weaknesses of public hospitals, the objectives of the hospital RPs will be undermined and the decentralization process in the health system will gradually reach a dead-end.

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Section: Introductionmentioning

confidence: 99%

Health decentralization at a dead-end: towards new recovery plans for Italian hospitals

Mauro

Maresso²,

Guglielmo

2017

Health Policy

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“…The tax is neutral with respect to choice of organizational form, and to equity versus debt …nancing. 8 As for the tax rate, strict limitations on regional rates have existed since its introduction: until 2007, a baseline rate of 4.25% was set nationwide, and regions were allowed to vary it by one percentage point. The central rate was then uniformly reduced to 3.90% in 2008, leaving regions the possibility of increasing or decreasing it by 0.92 percentage points.…”

Section: Empirical Analysis: Datamentioning

confidence: 99%

“…9 While the Italian regions have been in charge of managing and delivering health care services for over thirty years, the issue of the …nancing of regional health expenditures is still amply debated. During the late 1990s and early 2000s, the own revenue structure of the regions was deeply reformed with the aim of raising the health care budget share to be funded by own revenues and fostering regional government accountability (Bordignon and Turati, 2009;Ferrario and Zanardi, 2011). Moreover, the state and the regions agreed in principle on a system of rewards and sanctions to control excessive increases in expenditures and prevent the creation of budget de…cits.…”

Section: Empirical Analysis: Datamentioning

confidence: 99%

Tax Mandates and Factor Input Use: Theory and Evidence from Italy

Revelli¹

2015

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“…increasing taxes or patient co-payments). This worked for a while as real public health spending fell, but the deficits reappeared and state bailing-out of the regions resumed (Bordignon and Turati, 2009).…”

Section: Italy's Two Speed Devolution Modelmentioning

confidence: 99%

The rise of the regulatory state in health care: a comparative analysis of the Netherlands, England and Italy

Helderman

Bevan

France

2012

HEPL

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In a relatively short time, regulation has become a significant and distinct feature of how modern states wish to govern and steer their economy and society. Whereas the former ‘dirigiste’ state used to be closely related to public ownership (e.g. hospitals), planning (volume and capacity planning) and centralised administration (e.g. fixed prices and budgets), the new regulatory state relies mainly on the instrument of regulation to achieve its objectives. In this paper, we wish to relate the rise of the ‘regulatory state’ to the path-dependent trajectories and institutional legacies of discrete European health-care systems. For this purpose, we compared the Dutch corporatist social health insurance system, the strongly centralised National Health Service (NHS) of England and federal regionalised NHS system of Italy. Comparing these three different health-care systems suggests that it is indeed possible to identify a general trend towards the rise of the regulatory state in health care in the last two decades. However, although the three countries examined in this paper face similar problems of multilevel governance of networks of third-party payers and providers, each system also gives rise to its own distinct regulatory challenges.

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Bailing out expectations and public health expenditure

Cited by 141 publications

References 22 publications

Health decentralization at a dead-end: towards new recovery plans for Italian hospitals

Health decentralization at a dead-end: towards new recovery plans for Italian hospitals

Tax Mandates and Factor Input Use: Theory and Evidence from Italy

The rise of the regulatory state in health care: a comparative analysis of the Netherlands, England and Italy

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