University of Torino, Turin, Italy; HERMES, Moncalieri, Italy; Ceris-CNR, Moncalieri, Italy.
Health Econ. 2014 Feb;23(2):199-224. doi: 10.1002/hec.2910. Epub 2013 Feb 14.
This paper aims to assess the impact on citizens' well-being of fiscal discipline imposed by the central government on subnational governments. Because healthcare policies involve strategic interactions between different layers of governments in many different countries, we focus on a particular dimension of well-being, namely citizens' health. We model fiscal discipline by considering government expectations of future deficit bailouts from the central government. We then study how these bailout expectations affect the expenditure for healthcare policies carried out by decentralized governments. To investigate this issue, we separate efficient health spending from inefficiencies by estimating an input requirement frontier. This allows us to assess the effects of bailout expectations on both the structural component of health expenditure and its deviations from the 'best practice'. The evidence from the 15 Italian ordinary statute regions (observed from 1993 to 2006) points out that bailout expectations do not significantly influence the position of the frontier, thus not affecting citizens' health. However, they do appear to exert a remarkable impact on excess spending.
本文旨在评估中央政府对地方政府实施财政纪律对公民福祉的影响。由于医疗政策涉及许多国家不同层次政府之间的战略互动，我们关注福祉的一个特定维度，即公民健康。我们通过考虑政府对中央政府未来赤字救助的预期来模拟财政纪律。然后，我们研究这些救助预期如何影响分散化政府实施的医疗政策支出。为了研究这个问题，我们通过估计投入需求前沿来将有效医疗支出与低效支出区分开来。这使我们能够评估救助预期对健康支出的结构组成部分及其与“最佳实践”的偏差的影响。来自意大利 15 个普通州（1993 年至 2006 年观察）的证据表明，救助预期不会显著影响前沿的位置，因此不会影响公民健康。然而，它们似乎对过度支出产生了显著影响。
