The effects of Fiscal Decentralisation on access to care and healthcare disparities: International evidence and the Italian experience

财政分权对获得护理和医疗保健差异的影响：国际证据和意大利经验

• 批准号: 1917473
• 金额: --
• 依托单位: Queen Mary University of London
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-1917473
• 关键词: effects; Fiscal; Decentralisation; access; care

IntroductionFiscal decentralisation consists in the transfer of pooling and spending responsibilities from the central government to lower levels of governance within a country. Health sector fiscal decentralisation (FDH) has been central in the health policy debate as an option to achieve national cost-efficiency. However, its effects on access to care and healthcare disparities remain largely unexplored.MethodsThis research employs a mixed methods approach consisting of a systematic literature review, a thematic policy analysis, and a panel data analysis. The aim is to evaluate the effect of FDH in diverse country contexts; to explore FDH policy process in Italy and to estimate its impact on multiple dimensions of access to care - i.e. availability, accessibility, and utilisation of care - and on healthcare inequities in Italian regions. Results and discussionOverall, the implementation of FDH has a detrimental effect on the quality and provision of care, as well as on pre-existing disparities in health and access. In Italy, FDH policies gradually replaced central pooling of revenues with local earmarked taxes to fund regional healthcare services. The shift is correlated to cuts on the supply side and to reduced utilisation of care at local levels. Additionally, FDH decreased accessibility to local healthcare services and expanded regional medical tourism, the effect being stronger for patients residing in poorer areas. Results suggest that in Italy FDH has facilitated national cost control strategies at the expenses of reduced access to care at local levels. The effect perpetuates existing inequities between northern and southern regions of the country.

介绍财政分权包括在汇集和支出的责任从中央政府转移到较低层次的治理在一个国家。卫生部门的财政权力下放一直是卫生政策辩论的核心，是实现国家成本效益的一种选择。然而，它的影响，获得护理和医疗差距仍然在很大程度上unexplored.MethodsThis研究采用了混合方法的方法，包括系统的文献综述，专题政策分析，和面板数据分析。其目的是评估不同国家背景下的外籍家庭医生的影响;探讨意大利的外籍家庭医生政策过程，并估计其对获得护理的多个方面的影响-即护理的可用性，可及性和利用率-以及意大利地区的医疗保健不平等。结果和讨论总体而言，外佣的实施对护理的质量和提供，以及对预先存在的健康和获得的差距有不利影响。在意大利，外佣政策逐渐用地方专项税收取代了中央集中收入的做法，以资助区域保健服务。这种转变与供应方的削减和地方一级护理利用率的降低有关。此外，外佣减少了当地医疗服务的可及性，并扩大了区域医疗旅游，对居住在贫困地区的患者的影响更大。结果表明，在意大利，外籍家政服务员促进了国家成本控制战略的费用减少获得护理在地方一级。这种影响使该国北方和南方地区之间现有的不平等永久化。