Efficiency and equity effects of healthcare decentralization: evidence from Italy

The chapter starts with a review of the literature comparing first and second-generation models of fiscal federalism. The chapter then moves to explore the main trade-off between welfare and asymmetric information between first- and second-generation models of fiscal federalism. Next the chapter look at general theories of decentralization to theories of decentralization applied to the healthcare sector and review the literature on the role of health policies at the central and local levels. We do this with reference, but not only, to the Italian experience. Finally, it draws conclusion and mentions the next steps, especially in light of the problems emerged during the pandemics in Italy, which can be taken on how to restructure the health institutions in Italy in the aftermath of the Covid-19 pandemic.