Bureaucratic institutional design: the case of the Italian NHS

B-Tier
Journal: Public Choice
Year: 2018
Volume: 177
Issue: 3
Pages: 265-285

Score contribution per author:

0.670 = (α=2.01 / 3 authors) × 1.0x B-tier

α: calibrated so average coauthorship-adjusted count equals average raw count

Abstract

Abstract We propose a model where a regional government’s choice of the number of bureaucratic agencies operating in a region depends upon the degree of substitutability and complementarity of the bureaucratic services being demanded. We show that, if the government perceives the citizens’ demand as a demand for substitutable services, it will choose provision by two independent agencies. If the government perceives the citizens’ demand as a demand for complementary services, it will choose provision by a single consolidated agency. Exogenous shocks to the number of citizens amplify these incentives. Evidence from the Italian National Health Service (NHS) supports this hypothesis. Results show a positive effect of proxies of substitutable services on the number of regional local health authorities and a negative effect of proxies of complementary services. The major immigration amnesties, taken as shocks to the number of citizens entitled to the service, magnify these effects.

Technical Details

RePEc Handle
repec:kap:pubcho:v:177:y:2018:i:3:d:10.1007_s11127-018-0569-6
Journal Field
Public
Author Count
3
Added to Database
2026-01-25