Does Decentralization Matter in Health Outcomes? Evidence from 22 OECD Unbalanced Panel Data for 1995–2005

Kang, Young Ju; Cho, Wonhyuk; Jung, Kwang Ho

doi:10.1080/12264431.2012.10805215

Cited by 18 publications

(17 citation statements)

References 69 publications

(96 reference statements)

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“…6 Nonetheless, even without the framework law limits to diversity, diversity can be reduced if there are inceptives for policy transfer. Hence, the overall longer term effects on inequalities over time are ambiguous (Besley and Kudamatsi, 2006;Kang et al, 2012).…”

Section: Decentralization and Regional Inequalities In Government Actmentioning

confidence: 99%

Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?

Costa‐Font

Turati

2016

SSRN Journal

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Does regional decentralization threaten the commitment to regional equality in government outcomes? We attempt to shed light on this question by drawing on unique evidence from the largest European unitary states to have engaged in countrywide health system decentralization: Italy and Spain. We estimate, decompose, and run counterfactual analysis of regional inequality in government output (health expenditure per capita) and outcome (health system satisfaction) during expansion of health care decentralization in both countries. We find no evidence of increase in regional inequalities in outcomes and outputs in the examined period. Inequalities are accounted for by differences in health system design. JEL-Codes: H700, I180, I300.

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Section: Decentralization and Regional Inequalities In Government Actmentioning

confidence: 99%

Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?

Costa‐Font

Turati

2016

SSRN Journal

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“…Assessing health outcomes can also be attractive from a political point of view because it demonstrates how key policy reforms are affecting the overall population health. Among all health outcome measures, a more immediate measure is infant mortality rates (IMR), which is accurately measured by birth registries (Kang, Cho, & Jung, 2012;Pascual & Cantarero, 2005;H. Uchimura, 2008;M.…”

Section: Resultsmentioning

confidence: 99%

“…This increased accountability expedites the bureaucratic process and induces policy innovation as regions become more competitive (Kang et al, 2012). Further, it improves community participation in decision making and implementation, increasing the level of representation of local populations (Mansuri & Rao, 2004) and aligning public services more closely with local preferences (Kang et al, 2012). In addition, corruption was also said to be lower in countries wherein subnational governments have a larger share of fiscal revenues and expenditures (Altunbaş & Thornton, 2012;Thornton, 2012).…”

Section: Figure 61 Types Of Decentralizationmentioning

confidence: 99%

“…Decentralized healthcare system is asserted to ensure increased government accountability to the population (Bossert, Larranaga, Giedion, Arbelaez, & Bowser, 2003;Jiménez-Rubio, 2011;Kang et al, 2012). This increased accountability expedites the bureaucratic process and induces policy innovation as regions become more competitive (Kang et al, 2012). Further, it improves community participation in decision making and implementation, increasing the level of representation of local populations (Mansuri & Rao, 2004) and aligning public services more closely with local preferences (Kang et al, 2012).…”

Section: Figure 61 Types Of Decentralizationmentioning

confidence: 99%

Section: Figure 61 Types Of Decentralizationmentioning

confidence: 99%

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Health systems strengthening in global and national contexts

Macarayan¹

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Despite advances in medical research, the burden of disease in most countries remains high.Further, health inequalities continue to grow and emerging infectious diseases are still wreaking havoc across countries. To respond to contemporary public health challenges, a new systems thinking paradigm has emerged that highlighted a holistic approach towards health systems, resulting to an emerging field -health policy and systems research (HPSR). HPSR seeks to understand and enhance how societies organize themselves in achieving collective health goals, and how different actors interact in the policy and implementation processes. However, research gaps remain particularly in applying this paradigm to strengthen health systems performance across countries. This thesis contributes to HPSR by: a. examining the underlying concepts of health systems strengthening; b. determining how health systems contribute to better health outcomes, particularly on reducing infant mortality rates and improving life expectancies at birth, and c. understanding mechanisms to use findings from health systems strengthening assessments to inform global and national-level health policymaking processes.In 2015, 40% of the Global Fund investments go toward health systems strengthening (HSS). The global health threats posed by recent viral epidemics such as Ebola and Zika even further increased calls to invest in and develop better health systems. These health systems investments were also in most cases subjected to performance-based funding, but contrary to other monitoring and evaluation methods used for other health programs, health systems monitoring and evaluation demand a new analytical frame due to its complexity, along with the very different country capacities, uneven data sources and data availability and quality, including the varied contexts that drive priority areas for health systems. As such, monitoring these initiatives remain to be highly contentious despite its importance to inform health resource allocation. In particular, studies often highlighted different conceptual and methodological challenges associated with health systems assessments worldwide.To address these issues, I first introduced a new HSS framework based on existing monitoring and evaluation frameworks collected from my field experience, systematic reviews, and thematic analyses of existing HSS documents and database. Based on the developed HSS framework, existing HSS indicators were also examined to guide further analysis. Further, I quantitatively assessed health systems performance using a new composite indicator based on previous efforts for a global health systems performance index. To do this index, I used data collected from the Demographic Health Surveys, the World Bank Indicators, and the World Health Organisation ii (WHO) Global Health Surveys. In particular, I used fixed-effects and random-effects regression analyses to determine how each health system characteristic affects health outcomes, particularly infant mortality rates and life expectan...

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District‐level impacts of health system decentralization in Indonesia: A systematic review

Rakmawati

Hinchcliff

Pardosi

2019

Health Planning & Management

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Summary The local‐level impacts of decentralizing national health systems are significant yet infrequently examined. This review aims to assess whether localized health services delivery in Indonesia, which commenced a health system decentralization process in 2001, achieved its objectives or could be enhanced. A systematic review was undertaken to collate published evidence regarding this topic and synthesize key findings holistically using the six building blocks framework of the World Health Organization (WHO) to categorize health system performance. Four research databases were searched in 2016 for relevant evidence published between 2001 and 2015. The inclusion criteria were relevance to the topic of decentralization impacts at the district level, original research, and published in English. Included articles were appraised for quality using a standardized tool, with key findings synthesized using the WHO building blocks. Twenty‐nine articles met the inclusion criteria and categorized under the WHO building blocks categories. The findings highlight problematic impacts of decentralization related to three building blocks: service delivery, health financing, and workforce. In the 15 years of post‐decentralization in Indonesia, the service delivery, health workforce, and health financing blocks should be prioritized for further research and policy evaluation to improve the overall health system performance at the district level.

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Does Decentralization Matter in Health Outcomes? Evidence from 22 OECD Unbalanced Panel Data for 1995–2005

Cited by 18 publications

References 69 publications

Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?

Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?

Health systems strengthening in global and national contexts

District‐level impacts of health system decentralization in Indonesia: A systematic review

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