National healthcare systems are under financial pressure around the globe. One commonly suggested reform involves decentralisation. This column argues that the success of healthcare decentralisation depends on the political and design incentives. But if successful decentralisation is achieved, it can result in higher satisfaction and more fairness at no additional cost.

What policies can narrow the huge gap between the rich and the poor within India and other South Asian countries? One way is to devolve power to local governments in the hope they can better target the poverty. This column argues that simply directing financial resources to poor regions is not enough and needs to be complemented with increases in capacity and accountability of the local authorities.

Devolution can have incongruous effects on equality. Decentralisation of powers and resources to lower tiers of government can either increase or reduce interpersonal inequalities, depending on characteristics of the devolved region. This column uses data from regions of Western Europe to show that greater fiscal decentralisation is associated with lower income inequality.