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 (LHAs) 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.

Bureaucratic institutional design. The case of the Italian NHS / Fedeli, Silvia; Leonida, Leone; Santoni, Michele. - In: PUBLIC CHOICE. - ISSN 0048-5829. - STAMPA. - (2018), pp. 1-21. [10.1007/s11127-018-0569-66]

Bureaucratic institutional design. The case of the Italian NHS

Fedeli, Silvia;Leonida, Leone
;
2018

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 (LHAs) 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.
bureaucratic institutional design, public local health authorities, consolidation and decentralization of local health authorities, Italian NHS
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Bureaucratic institutional design. The case of the Italian NHS / Fedeli, Silvia; Leonida, Leone; Santoni, Michele. - In: PUBLIC CHOICE. - ISSN 0048-5829. - STAMPA. - (2018), pp. 1-21. [10.1007/s11127-018-0569-66]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1113657
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