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A large literature examines government fiscal interactions in federations. However, the empirical evidence is scattered and inconclusive, especially with respect to the size of interactions, as well as the institutional and economic determinants underpinning them. This paper uses meta-regression analysis to quantify the size of these inter-jurisdictional fiscal interactions and to explain the heterogeneity in empirical estimates. First, we find significantly stronger interactions among municipalities and nations than among intermediate levels of government. Second, tax interactions are, in general, stronger than expenditure interactions, and horizontal tax interactions appear to be stronger than vertical interactions. Third, both tax competition and yardstick competition are supported by the data, though the former appears to produce stronger interactions. Fourth, capital controls, voter turnout and the design of decentralization all shape fiscal interactions; political competition and fiscal decentralization both increase horizontal tax competition and they decrease vertical tax competition. Finally, much of the variation between estimates can be explained by country heterogeneity, differences in econometric specification and estimation strategies.

Reforming Long-term Care in Europe offers the most up-to-date analysis of the features and developments of long-term care in Europe. Each chapter focuses on a key question in the policy debate in each country and offers a description and analysis of each system. Offers the very latest analysis of long-term care reform agendas in Europe Compares countries comparatively less studied with the experiences of reform in Germany, the UK, Netherlands and Sweden Each chapter focuses on a key question in the policy debate in each country and portrays a description and analysis of each system Contributions from a wide range of European scholars for an exceptionally broad perspective.

This paper explores different empirical strategies to examine the effect of cost sharing for prescription drugs in some dimensions of medication-related quality, namely the probability of inappropriate prescription drug use among United States seniors. Using data from 1996 to 2005, we explore various specifications that correct for sample selection, endogeneity, and unobserved heterogeneity. We find a small, but measurable, negative price elasticity for inappropriate drug use with respect to self-reported average out-of-pocket costs for all drugs consumed. That is, user fees reduce the use of potentially inappropriate medications, however the elasticity of cost sharing is lower than that of drugs in general and the price elasticity is relatively close to zero, suggesting that any quality improvements from co-payments are small.

AbstractHow does the deregulation of medicine influence access to drugs? This paper provides an economic policy assessment of the effects of medicine deregulation drawing on the Peruvian experience between 1991 and 2006. As in other low‐income countries, health insurance development is inadequate, drug expenditure is mostly paid out‐of‐pocket and approximately one third of the Peruvian population has limited access to 'essential medicines'. Market deregulation in this context could have exerted an impact on prices and hence reduce access to medicines. Based on this evidence, we find that product and price deregulation of the medicines market appears to have reduced consumer trust of locally produced medicines and incentivised a switch to branded and more expensive drugs. The latter resulted in a drug price spike, which in turn further decreased access to medicines. Copyright © 2015 John Wiley & Sons, Ltd.

AbstractUnderstanding long‐term care (LTC) reform is at the core of the study of European social policy. Particularly important are the effects of regional devolution on the development of LTC services, being one of the few areas only subject to limited welfare retrenchment. One important question is the extent to which a devolved system of welfare governance influences the process of welfare reform as well as the degree of diversity in the provision and financing of LTC. The article draws upon evidence from Italy and Spain, two 'Latin Rim' countries, both of which have faced similar demands over the last twenty years for reform of systems with limited entitlement to long‐term care. It argues that when there is a latent demand for reform, welfare devolution does not inhibit reform when fiscal blame‐avoidance opportunities arise at the central government level. Furthermore, we examine the extent to which devolution leads to increasing fragmentation and diversity. The article's findings indicate that by diffusing policy responsibilities, devolution has enhanced LTC reform and reduced pre‐existing welfare fragmentation in Spain. In contrast, the lack of countrywide reform in Italy is explained by the absence of political opportunities for the diffusion of the fiscal blame that has frustrated attempts to reform the existing national cash allowance.