Decentralization as a determinant of health care expenditure: empirical analysis for OECD countries

Territorial decentralization involves the transfer of responsibilities from a central government to lower levels of government. A common trend in different developed countries has been to decentralize some health functions (managerial and/or financial) to local governments. The set-up of the health care system and its degree of decentralization are here utilized in a panel data analysis as a determinant of health care expenditure in a sample of 20 Organization for Economic Co-operation and Development (OECD) countries for the period 1990 to 2000. These findings lend support that demographic, supply-related and socio-economic factors impact on overall health care costs and a decentralized health care setting implies higher health expenditure.