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Session Four: The Impact Decentralisation Performance Health Care Systems New Analysis, Meeting 2018

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14th Annual Meeting of the OECD Network on Fiscal Relations Across Levels of Government, 19-20 November 2018

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Session Four: The Impact Decentralisation Performance Health Care Systems New Analysis, Meeting 2018

  1. 1. THE IMPACT OF DECENTRALISATION ON THE PERFORMANCE OF HEALTH CARE SYSTEMS: INSIGHTS FROM NEW ANALYSES Luca Lorenzoni and Alberto Marino 14th Annual Meeting of the Network on Fiscal Relations Across Levels of Government, 19-20 November 2018
  2. 2. • To explore the impact of varying degrees of cross-country administrative decentralisation on key health dimensions: Aim of the analysis Life expectancy Health spending Hospital costs Which policies increase value for money in health care (Lorenzoni et al., 2018) Understanding variations in hospital costs (Lorenzoni and Marino, 2017) Decentralisation component added to two recent analyses:
  3. 3. • Index of decentralisation extracted from: – OECD Survey on Health Systems Characteristics (2008) – Joint survey of the Fiscal Network and Joint Network of SBO (2018) • Degree of decentralisation (0-6) in the decision making process across 13 policies or service areas, based on the following classification: • For the hospital costs analysis, countries were then classified, based on 2008 and 2018 responses, as either “low”, “high and decreasing” or “high and increasing” decentralisation Indicator of decentralisation 0 = Only central 3 = Both central and local 6 = Only local
  4. 4. Health spending, life expectancy and decentralisation -0.5 -0.4 -0.3 -0.2 -0.1 0.0 0.1 0.2 0.3 0.4 0.5 -1.5 -1 -0.5 0 0.5 1 1.5 0 1 2 3 4 5 6 Expenditure (left axis) Life expectancy (right axis) Effect on expenditure Effect on life expectancy Degree of decentralisation (6 = highest) • A higher degree of decentralisation reduces public health spending and increases life expectancy • “Excessive” decentralisation reverses this effect, with significantly reduced life expectancy and increased health spending • Results are fairly robust to the introduction of decentralisation, although there are concerns for overfitting
  5. 5. 53% lower costs on average High decreasing Hospital costs Mixed effect across conditions High increasing Compared to low decentralis ation Compared to low decentralis ation Higher costs across conditions High increasing Compared to high and decreasing • The impact of decentralisation on hospital cost is broadly consistent with findings from health spending analysis • Coefficients for other controls do not vary significantly as decentralisation is introduced • Since the index is based on two data points and a limited number of OECD countries with data, some explanatory power is lost on the hierarchical structure of the model
  6. 6. • Luca Lorenzoni (luca.lorenzoni@oecd.org) • Alberto Marino (alberto.marino@oecd.org) Thank you!

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