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Does regional decentralization threaten the commitment to regional equality in government outcomes? We attempt to shed light on this question by drawing on unique evidence from the largest European unitary states to have engaged in countrywide health system decentralization: Italy and Spain. We estimate, decompose, and run counterfactual analysis of regional inequality in government output (health expenditure per capita) and outcome (health system satisfaction) during expansion of health care decentralization in both countries. We find no evidence of increase in regional inequalities in outcomes and outputs in the examined period. Inequalities are accounted for by differences in health system design.

In a career-concern model of politics with endogenous candidacy and different types of politicians, following a decentralization reform, politicians with different skills are elected in municipalities characterized by different levels of autonomous resources. As an effect, consumer welfare increases only, or mainly, in richer municipalities. We test these predictions by exploiting the differentiated reduction in Vertical Fiscal Imbalance in Italian municipalities, due to the strong difference in the tax base, following the decentralization reforms of the '90s. Results strongly support our predictions and are robust to several alternative stories.

In a career-concern model of politics with endogenous candidacy and different types of politicians, following a decentralization reform, politicians with different skills are elected in municipalities characterized by different levels of autonomous resources. As an effect, consumer welfare increases only, or mainly, in richer municipalities. We test these predictions by exploiting the differentiated reduction in Vertical Fiscal Imbalance in Italian municipalities, due to the strong difference in the tax base, following the decentralization reforms of the '90s. Results strongly support our predictions and are robust to several alternative stories.

The objective of the paper is to study the disciplining role of both market forces and regional governments own resources in the provision of educational services. The historical evolution of school regulation in Italy and Spain (in particular regarding the funding of private schools run by Roman Catholic Church, and the role of regional governments financing education) created different institutions in terms of both dimensions, private funds and regional governments funds. We take advantage of these institutional diversities to estimate the disciplining role of different sources of funds in the context of educational production function using PISA data. Our results provide support to these accountability drivers. Moreover, we find evidence on the role played by a national standardised test in providing adequate incentives to improve schools' performance.

"This groundbreaking Handbook brings together the two timely subject matters of political economy of health and health care into one comprehensive book. Containing up-to-date discussions on these key topics, it provides an interdisciplinary approach and a better understanding of health policy making. Highlighting the key theoretical and empirical debates in academia and policy across a variety of scholarly groups, this Handbook shows the differing methods and principles applied while sharing the common goal of understanding the institutional mechanisms, constraints and determinants that influence decision-making. Split into six thematic parts, the expert contributors discuss the design of health care systems, political markets, financing and policy reforms, and healthcare during pandemics, as well as providing insightful lessons to be learnt for the future. Scholars and professionals interested in an in-depth state-of-the-art companion to the main issues under discussion of the effects of the design in our health systems, along with the constraints that they face, will find this Handbook an excellent resource"--

"With the proliferation of academic journals and the increased importance attributed to research papers for academic careers, the tradition of writing book manuscripts has become less popular in social sciences. However, there still is a point in writing a book to provide an 'unified overview' of specific field of research. This is especially the case when the research produced in a specific field has set the foundations of an independent field of study which can be labeled as the 'political economy of health and health care'. Increasingly, scholars of different disciplines such as economics, politics, sociology, health sciences among others, have produced a wealth of knowledge on how political institutions and processes influence the dynamics and performance of health systems. Most of these contributions, however, tend to be scattered, and often fail to speak to each other when they probably should for the discipline to continue advancing. The purpose of this book has been to build a bridge between disciplines and help contribute to a unified perspective."

We exploit variation across Italian Regions in the implementation of region-specific tariffs within a Prospective Pay System (PPS) for hospitals based on Diagnosis Related Groups (DRG) to assess their impact on health and on the use of health care services. We consider survey data for the years 1993-2007 with information on both individuals' perceived health and their utilization of health care services. Results suggest that the introduction of market incentives via a fixed-price payment system did not lead to worst health perceptions. Instead, it marked a moderate decrease in hospitalization coupled with a clearer decrease in the utilization of emergency services. We also find mild evidence of reduced satisfaction with health care services among hospitals patients. These effects were stronger for adoptions occurring when also the national government supported the market-based approach. Results are robust to a number of sensitivity checks.