Electoral Accountability and Local Government Efficiency: Quasi-Experimental Evidence from the Italian Health Care Sector Reforms

University of Bari SERIES Working Paper No.36

35 Pages Posted: 22 Sep 2011  

Francesco Porcelli

University of Warwick

Date Written: September 2011

Abstract

This paper evaluates the effect of two policy changes on the efficiency of Italian regional governments in the provision of health care services: first a change in the electoral system; second a process of fiscal decentralization. The electoral system was changed in 1995 and replaced a pure proportional system by a majoritarian system, fostering the transition of regional governments towards a presidential regime. The process of fiscal decentralization took effect in 1998, when intergovernmental grants earmarked for the health care sector were replaced by regional taxes. The Italian context offers a unique source of data to test the predictions of recent theoretical models that support a positive relationship between government efficiency and the electoral accountability enhanced by institutions such as electoral rules and fiscal decentralization. The paper provides two main contributions: a comprehensive analysis of the two main reforms that involved Italian regional governments and the health care sector during the 1990s; the evaluation of the impact of the electoral reform in a quasi-experimental setting. The final results provide empirical evidence in line with the findings of the theoretical models.

Keywords: electoral accountability, DEA, decentralisation, efficiency, health, IRAP, Italy, panel data, stochastic frontier

JEL Classification: D71, D91, I32

Suggested Citation

Porcelli, Francesco, Electoral Accountability and Local Government Efficiency: Quasi-Experimental Evidence from the Italian Health Care Sector Reforms (September 2011). University of Bari SERIES Working Paper No.36 . Available at SSRN: https://ssrn.com/abstract=1932052 or http://dx.doi.org/10.2139/ssrn.1932052

Francesco Porcelli (Contact Author)

University of Warwick ( email )

Gibbet Hill Rd.
Coventry, West Midlands CV4 8UW
United Kingdom

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