Abstract
In this paper, we examine the impact of decentralization of health care administration on inequity in health care access in Canada. We extend previous studies in two ways. First, to explore the spatial dimension of inequity, we adopt a perfect decomposable inequality measure—the Theil index—in our analysis. Secondly, we conduct a before and after comparison of a change in the degree of decentralization in Canada—the introduction of the CHST in 1996/1997. This may shed some lights on the casual relationship between decentralization and health-related inequity. The results of our analysis show that the overall inequity in health care utilization is mostly explained by variations within provinces in Canada. The increase in the degree of decentralization is related to lower degree of overall and within-province inequity in the use of GP and hospital services, and lower between-province inequity in the use of all the three health care variables examined in this paper.
Similar content being viewed by others
References
Akin J., Hutchinson P., Strumpf K. (2005) Decentralisation and government provision of public goods: The public health sector in Uganda. The Journal of Development Studies 41(8): 1417–1443
Besley T., Case A. (1995) Incumbent’s behavior: Vote seeking, tax-setting and yardstick competition. American Economic Review 85: 25–45
Biewen M. (2002) Bootstrap inference for inequality, mobility and poverty measurement. Journal of Econometrics 108: 317–342
Bossert T. J., Beauvais J. C. (2002) Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: A comparative analysis of decision space. Health Policy and Planning 17(1): 14–31
Bossert T. J., Larranaga O., Giedion U., Arbelaez J. J., Bowser D. M. (2003) Decentralization and equity from resource allocation: Evidence from Colombia and Chile. Bulletin of the World Health Organization 81(1): 95–100
Canadian Institute for Health Information: (2007) National health expenditure trends, 1975 to 2006. CIHI, Ottawa
Conceicao, P., & Ferreira, P. (2000). The young person’s guide to the Theil Index: Suggesting intuitive interpretations and exploring analytical applications. UTIP working paper number 14. The University of Texas at Austin.
Costa-Font J., Pons-Novell J. (2007) Public health expenditure and spatial interactions in a decentralized national health system. Health Economics 16: 291–306
Costa-Font J., Rico A. (2006) Devolution and the inter-regional inequalities in health and health care in Spain. Regional Studies 40(8): 875–887
Cowell F. A. (2000) Measurement of inequality. In: Atkinson A. B., Bourguigon F. (eds) Handbook of income distribution. Elsevier, North-Holland, Amsterdam
Crivellia L., Filippinia M., Mosca I. (2006) Federalism and regional health care expenditures: An empirical analysis for the Swiss cantons. Health Economics 15: 535–541
Davidson R., Flachaire E. (2007) Asymptotic and bootstrap inference for inequality and poverty measures. Journal of Econometrics 141: 141–166
Habibi, N., Huang, C., Miranda, D., Murillo, V., Ranis, G., Sarkar, M., et al. (2001) Decentralization in Argentina. Center discussion paper no. 825. Economic Growth Centre, Yale University, CT.
Jimenez-Rubio D., Smith P., Van Doorslaer E. (2008) Equity in health and health care in a decentralized context: Evidence from Canada. Health Economics 17: 377–392
Jones A. M. (2000) Health econometrics. In: Culyer A. J., Newhouse J. P. (eds) Handbook of health economics. Elsevier, North-Holland
Kakwani N. C., Wagstaff A., Van Doorslaer E. (1997) Socioeconomic inequalities in health: Measurement, computation and statistical inference. Journal of Econometrics 77: 87–104
Lopez-Casasnovas G., Costa-Font J., Planas I. (2005) Diversity and regional inequalities: Assessing the outcomes of the Spanish system of health care services. Health Economics 14(S): S221–S235
Maasoumi E. (1997) Empirical analyses of inequality and welfare. In: Pesaran M., Schmidt P. (eds) Handbook of applied econometrics: Microeconomics. Blackwell, Oxford, pp 202–245
Marchildon, G. P. (2005). Health systems in transition. European Observatory on Health Systems and Policies, 7(3). http://www.euro.who.int/Document/E87954.pdf.
Mills J., Zandvakili S. (1997) Statistical inference via bootstrapping for measures of inequality. Journal of Applied Econometrics 12: 133–150
O’Donnell O., van Doorslaer E., Wagstaff A., Lindelow M. (2008) Analyzing health equity using household survey data: A guide to techniques and their implementation. The World Bank, Washington
Pedersen K., Christiansen T., Bech M. (2005) The Danish health care system: Evolution—not revolution—in a decentralized system. Health Economics 14: S41–S57
Pollock A. M. (1999) Devolution and health: Challenges for Scotland and Wales. British Medical Journal 318: 1195–1198
Reverte-Cejudo D., Sanchez- Bayle M. (1999) Devolving health services to regions in Spain. British Medical Journal 318: 1204–1205
Scheffler R., Smith R. (2006) The impact of government decentralization on county health spending for the uninsured in California. International Journal of Health Care Finance and Economics 6: 237–258
Snoddon T. R. (1998) The impact of the CHST on interprovincial redistribution in Canada. Canadian Public Policy 24(1): 49–70
Theil H. (1967) Economics and information theory. Rand McNally and Company, Chicago
Tresch R. W. (2002) Optimal federalism: Sorting the functions of government within the fiscal hierarchy. Public finance: A normative theory. Academic Press, San Diego
Van Doorslaer E., Koolman X., Jones A. M. (2004) Explaining income-related inequalities in health care utilisation in Europe. Health Economics 13(7): 629–647
Van Doorslaer, E., Masseria, C., & Koolman, X. The OECD Health Equity Research Group. (2006). Inequalities in access to medical care by income in developed countries. Canadian Medical Association Journal, 174(2), 177–183.
Wagstaff A., Van Doorslaer E. (2000) Equity in health care finance and delivery. In: Culyer A. J., Newhouse J. P. (eds) Handbook of health economics. Elsevier, North-Holland
West L. A., Wong C. P. (1995) Fiscal decentralization and growing regional disparities in rural China: Some evidence in the provision of social services. Oxford Review of Economic Policy 11(4): 71–84
World Health Organization. (2003). European observatory on health care systems website. http://www.euro.who.int/observatory. Accessed June 2007.
Zhong, H. (2009). The impact of missing data in the estimation of concentration index: A potential source of bias. The European Journal of Health Economics. doi:10.1007/s10198-009-0170-5.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhong, H. The impact of decentralization of health care administration on equity in health and health care in Canada. Int J Health Care Finance Econ 10, 219–237 (2010). https://doi.org/10.1007/s10754-010-9078-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10754-010-9078-y