An evaluation of the 1997 fiscal decentralization reform in Mexico : the case of the health sector

This paper studies the impact of the health decentralization of funds and responsibilities that took place in Mexico in 1997 on state level health outcomes. It renders two main results. First, the magnitude of transfers from the federal government to states failed to take into account state-specific needs; instead, transfers were mainly determined by the pre-reform health expenditures of the federal government in each state. Second, decentralization did not boost the advances in health outcomes already achieved under the centralized health sector regime. We conclude by discussing plausible reasons for the disappointing impact of decentralization on health outcomes. -- Fiscal decentralization ; federalism ; health