Abstract
Spatial inequalities in publicly provided goods such as health care facilities have substantial socio-economic effects. Little is known, however, as to why publicly provided goods diverge among urban and rural regions. We exploit narrow parliamentary majorities in German states between 1950 and 2014 in an RD framework to show that government ideology influences the urban-rural gap in public infrastructure. Leftwing governments relocate hospital beds from rural regions. We propose that leftwing governments do so to gratify their more urban constituencies. In turn, spatial inequalities in hospital infrastructure increase, which seems to influence general and infant mortality.
Highlights
Local differences in the utilization of publicly provided goods such as healthcare facilities influence morbidity and mortality, especially in underutilized rural regions (e.g., Buchmueller, Jacobson, & Wold, 2006; Zhang & Kanbur, 2005)
The results do not suggest that government ideology influences the scope of hospital infrastructure
We have focused on publicly provided goods as an important, but yet hardly investigated policy outcome
Summary
Local differences in the utilization of publicly provided goods such as healthcare facilities influence morbidity and mortality, especially in underutilized rural regions (e.g., Buchmueller, Jacobson, & Wold, 2006; Zhang & Kanbur, 2005). In many German states, left- or right-wing governments rely on a one-seat majority only, which is a result of polarization and tight political races in state elections Smaller parties such as the Green Party or the market-oriented party FDP often scatter around the 5% vote-share threshold that is required to enter state parliaments. Our RD estimator measures the local average treatment effect, describing whether closely elected left-wing governments differ from their right-wing counterparts in implementing hospital policies.. Our RD estimator measures the local average treatment effect, describing whether closely elected left-wing governments differ from their right-wing counterparts in implementing hospital policies.11 This gives the causal effect of government ideology on hospital infrastructure and spatial inequalities. To rule out any bias of confounding factors, we include all control variables in our RD specifications
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