The interest in the factors involved in rising health care expenditure has created a third generation industry which is exploring data and econometric issues (see Gerdtham and Jönsson, 2000). However a common element missing from research, even in Gerdtham and Jönsson's agenda, is a consideration of the regional composition within the national health expenditure figures. An aggregation fallacy in estimating the income elasticity of health expenditure may therefore result from it.In order to study this, we have applied a multilevel hierarchical model using data for 110 regions in eight OECD countries in 1997: Australia, Canada, France, Germany, Italy, Spain, Sweden and United Kingdom. In doing this we have tried to identify two sources of random variation: within countries and betweencountries. The basic purpose is to find out if the different relationships between health care spending and the explanatory variables are country-specific. Our results show that: 1-Variability between countries amounts to (SD) 0.5433, and just 13% of that can be attributed to income elasticity and the remaining 87% to autonomous health expenditure; 2-Within countries, variability amounts to (SD) 1.0249; and 3-The intra-class correlation is 0.5300. We conclude that we have to take into account the degree of fiscal decentralisation within countries in estimating income elasticity of health expenditure. Two reasons lie behind this: a) where there is decentralisation to the regions, policies aimed at emulating diversity tend to increase national health care expenditure; and b) without fiscal decentralisation, central monitoring of finance tends to reduce regional diversity and therefore decrease national health expenditure. The results do seem to validate both these points.