“…Away from the “progressive opportunity”’ public value criterion that look at social inequities (Bozeman & Johnson, ), Italian decentralization increased territorial disparities regarding access (Ferrario & Zanardi, ; Pavolini & Vicarelli, ) and public expenditures for local infrastructure, but generated little or no economies of scale due to a lack of bargaining power that a single buyer such as a central government could produce. Moreover, the transparency of the local governments was not necessarily higher (da Cruz, Tavares, Marques, Jorge, & de Sousa, ). Spain, the most decentralized nation within the Organization for Economic Cooperation and Development (OECD), experienced a rise in health‐care expenditures (Joumard, André, & Nicq, ).…”