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The Impact of Devolution on Local Health System Financing: A Synthetic Difference-in-Differences Study of Greater
Charlie Moss1, Philip Britteon1, Yiu-Shing Lau1
1Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.
International Journal of Health Policy and Management
|April 12, 2026
Summary
Devolution in Greater Manchester increased total health and care spending by £66.58 per capita. Additional resources addressed existing pressures, but significant redirection requires more funding or service reorganization.
Area of Science:
- Health Services Research
- Public Health Policy
- Health Economics
Background:
- Evaluating devolution's impact on health system financing is crucial.
- Few studies assess total health and care expenditure post-devolution.
- This study examines Greater Manchester's devolved health and social care powers.
Purpose of the Study:
- To evaluate the impact of devolution on total local public health and care expenditures.
- To analyze changes in per capita spending and expenditure shares.
- To investigate dynamic effects of devolution on health and care spending.
Main Methods:
- Synthetic difference-in-differences (DiD) analysis of 149 local health systems (2013-2020).
- Comparison of Greater Manchester localities to a weighted control group from the rest of England.
- Event study specification to analyze dynamic effects.
Main Results:
- Total health and care expenditure in Greater Manchester increased by £66.58 per capita post-devolution.
- Public health and social care spending managed by Local Authorities rose by £36.39 per capita.
- Short-term shifts observed in NHS Clinical Commissioning Group expenditures; no significant effect on public health, primary care, community, or mental healthcare.
Conclusions:
- Devolved funds were utilized to manage existing health system pressures.
- Significant expenditure redirection necessitates increased resources or service reorganization alongside devolution.
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