Doctoral thesis

Three essays on the role of federalism in the Swiss healthcare system


82 p

Thèse de doctorat: Università della Svizzera italiana, 2015

English Switzerland is a country with a strongly decentralized political system, based on federalism and institutions of direct democracy, on a liberal economic culture, and on a well-developed tradition of mutualism and social security (generous social expenditure and welfare system). Switzerland is unique for its high level of decentralization and for the particular distribution of competences and roles between the central State (the Confederation) and the cantonal authorities. This particular setting allows cantons to have significant leeway in the organization of health care and the implementation of specific public policies. This thesis aims to give a contribution to the health economics literature, assessing some of the internal implications of the Swiss federal setting in the health care sector (chapters 1 and 2) and drawing some more general public policy results, exploiting the Swiss context (chapter 3). The first two chapters explore two different sides of the equity of the Swiss health care system. In the first chapter, I assess to what extent the political autonomy allocated to cantons leads to differences in the level of regressivity in the financing of the health care system and over time. The second chapter investigates the role of managed care contracts and higher deductible on the equity in health care utilization. Finally, in the third chapter I carry out a policy evaluation analysis to assess the causal effects of smoking bans on acute myocardial infarction. Different from the other two chapters, this work draws conclusions that abstract from the Swiss context. Switzerland is the perfect setting where to employ our empirical strategy, due to the different times of implementation of the policy if interest. However, the results have external validity. Each work is based on a different database: the first and the third are based on administrative data, while the second one relies on survey data.
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