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 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.
|Titolo:||Bureaucratic institutional design: the case of the Italian NHS|
|Parole Chiave:||Bureaucratic institutional design; public local health authorities; consolidation and decentralization of local health authorities; Italian NHS|
|Settore Scientifico Disciplinare:||Settore SECS-P/03 - Scienza delle Finanze|
|Data di pubblicazione:||dic-2018|
|Data ahead of print / Data di stampa:||25-giu-2018|
|Digital Object Identifier (DOI):||10.1007/s11127-018-0569-6|
|Appare nelle tipologie:||01 - Articolo su periodico|