Bureaucratisation and the growth of health care expenditures in Europe
The public choice literature suggests that bureaucrats might join forces with specific pressure and industrial groups which advocate an expansion of health care activities. As a result, the ongoing process of bureaucratisation can be a driving force behind the overproduction of health care services. In addition, Michel Foucault was the first to depict medicalisation and normalisation as processes part of a broader institutional infrastructure set up to control individuals. Both processes require a strong bureaucracy, established by the ruling elites. For our empirical analysis, the share of government employment in total employment has been used as a proxy for bureaucracy. Our results show that the process of bureaucratisation has a very significant and positive influence on national health care expenditures per capita in 20 European countries. Together with the evolution of per capita income, we can conclude that the ongoing bureaucratisation is one of the driving forces behind the rise of health care expenditures in Europe. A similar conclusion holds for the research intensity of the country. However, the combination of a high level of bureaucratisation and a high research intensity results in lowering per capita health expenditures. Our results furthermore confirm that the ageing of the population is consistently not significant once bureaucratisation is included in the analysis.
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