We show how regional governments affect the appropriate – in terms of territorial equity - assignment of a national LTC benefit. We analyse a three -layers setting, where eligibility criteria are defined by the central government (which bears the fiscal cost of transfers) but the assignment decision is taken by regional medical commissions, while applications are activated by individual potent ial beneficiaries. Combining administrative and survey data, and accounting for regional variation in eligibility prevalence, we document large territorial disparities in need - adjusted benefit assignment. We investigate the determinants of such disparities both in terms of individuals’ differential propensity to claim, and of regional discretionary behaviour, as shaped by the underlying quality of regional institutions. Regional discretion appears to play a major role, with local institutional quality accou nting for about one fifth of explained variation in need- adjusted benefit coverage. Lower regional institutional quality results in more opportunistic benefit adjudication decisions, although the relationship is attenuated in highly deprived areas.

Regional Institutional Quality and Territorial Equity in LTC Provision

Anna Marenzi;Dino Rizzi;Michele Zanette;Francesca Zantomio
2022-01-01

Abstract

We show how regional governments affect the appropriate – in terms of territorial equity - assignment of a national LTC benefit. We analyse a three -layers setting, where eligibility criteria are defined by the central government (which bears the fiscal cost of transfers) but the assignment decision is taken by regional medical commissions, while applications are activated by individual potent ial beneficiaries. Combining administrative and survey data, and accounting for regional variation in eligibility prevalence, we document large territorial disparities in need - adjusted benefit assignment. We investigate the determinants of such disparities both in terms of individuals’ differential propensity to claim, and of regional discretionary behaviour, as shaped by the underlying quality of regional institutions. Regional discretion appears to play a major role, with local institutional quality accou nting for about one fifth of explained variation in need- adjusted benefit coverage. Lower regional institutional quality results in more opportunistic benefit adjudication decisions, although the relationship is attenuated in highly deprived areas.
File in questo prodotto:
File Dimensione Formato  
WP_DSE_marenzi_rizzi_zanette_zantomio_15_22.pdf

accesso aperto

Tipologia: Documento in Pre-print
Licenza: Accesso libero (no vincoli)
Dimensione 1.07 MB
Formato Adobe PDF
1.07 MB Adobe PDF Visualizza/Apri

I documenti in ARCA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10278/5007440
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact