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Ms. Izabela Karpowicz
This paper describes the institutional changes that have induced a decline in the vertical fiscal imbalance (VFI) - defined as the share of sub-national own spending not financed through own revenues - in four European countries: Belgium, Italy, Norway, and Spain. The decline in VFI was achieved through progressive devolution of revenues to sub-national governments in Belgium, Italy, and Spain, while re-centralization of health sector expenditures was the cause of the decline in the VFI in Norway.
International Monetary Fund
This paper provides an analysis of the developments in public health spending over the past 40 years, as well as projections of public health spending for 50 advanced and emerging countries over 2011–50. The paper also quantifies the effects of specific health reforms on the growth of public health spending in advanced economies by drawing on a range of analytical approaches, including country case studies. The challenges facing emerging economies as they seek to expand coverage of health care in a fiscally sustainable manner are also examined
Mr. Ehtisham Ahmad, Mr. Giorgio Brosio, and Mr. Vito Tanzi
There is a widespread presumption that decentralization improves public service provision. This has led to policy prescriptions that are assiduously adhered to by countries and international. This paper reviews the recent evidence from OECD countries-which is seen to be inconclusive. This suggests the need for a careful design of programs that take into account the political economy constraints and incentives, as well as more systematic and thorough evaluations of outcomes.
International Monetary Fund
This Selected Issues paper examines Germany’s growth record in 1992–2001 and analyzes how future performance might be enhanced. The paper focuses on the longer-term strains on the public finances. It reviews Germany’s external competitiveness, which deteriorated substantially in the wake of unification, and concludes that, by the beginning of the current decade, competitiveness had been largely restored. The paper also examines the recent slowdown in credit, which has gone beyond what might be expected on cyclical grounds.
Mr. Franco Reviglio
In Italy, health care budget ceilings are not effective. The poor control by the central government results in excessive use of expensive inputs, in long waiting lines for medical procedures, and in the emergence of large arrears to suppliers and commercial banks. To fully gain the benefits of its decentralized structure, Italy needs to clarify the rules of the game and strengthen controls on local health authorities. Full fiscal responsibility should be extended to local governments on both the expenditure and revenue sides. The central government should be involved neither in decisions on the services that local governments should supply, nor in their planning and management.
International Monetary Fund
The paper examines macroeconomic and structural factors potentially explaining the country's underperformance. A comparison between the reform and baseline policy scenarios underscores maintaining a strong fiscal position, early reductions in primary expenditures, and reducing fiscal vulnerability. Assigning the financing and management of the health care system to the regions may increase the efficiency and the productivity of the health care system. The information on Italy's economy and legal as well as regulatory environment is available on the worldwide web, and the paper lists the related sites.
International Monetary Fund
This Selected Issues paper and Statistical Appendix constructs an index of human capital for the Spanish labor force over 1977–97, and projects it over the next decade on the basis of likely demographic developments. The methodology by which the index is constructed considers both educational attainments resulting from formal schooling and improvements in workers’ productivity resulting from experience, or “learning by doing.” The results suggest that the gains from increases in formal schooling can be large, although they are translated into higher economic growth only gradually.