Conceptualizing decentralization in European health systems: a functional perspective

Abstract

Although decentralization has been widely implemented in health systems, there is little agreement as to how it should be defined or the outcomes it should produce. This article develops a functional typology based on political, administrative, and fiscal dimensions of decentralization. It utilizes these three categories to identify and highlight key theoretical issues concerning decentralization, emphasizing the likely advantages and disadvantages that decentralization can be expected to generate. It then examines the usefulness of this functional framework in explaining recent policy-making decisions within a number of tax-based health systems in Western Europe. The article concludes by suggesting that this three-part typology can be helpful to both policy makers and academics in evaluating the effectiveness of decentralization as a policy mechanism within health care systems.

(De)centralization of social support in six Western European countries

“…The general idea behind decentralization is that at local level there is more knowledge about the circumstances and needs of the local population, which should lead to better services [1][2][3][4][5][6], that are organized more efficiently [5] and lead to a better accountability [7]. However, there may be unexpected and even negative effects [8][9][10], such as an uneven geographical distribution of financial, human, and supply resources; local governments may pursuit their own specific interests, making it difficult to establish and achieve national priorities and in practice the public appears to have less influence in decision making and assessing priorities as expected [6,11]. Centralization, on the other hand, has the advantage of equal rights for everyone, but may have costs in the sense of decreased accountability [12] and may result in a lesser fit between individual needs and provision.…”

“…According to Saltman and Bankauskaite [10] and Robinson [2] decentralization consists of three distinct concepts: political, financial and administrative decentralization. Decentralization of political power implies that local governments may formulate their own policy, resulting in more choice for citizens, less bureaucracy and more accountability, since local governments have a short distance to the citizens.…”

Effects on healthcare utilization of case management for frail older people: A randomized controlled trial (RCT)

“…To deal with increasing demand for healthcare and social services due to the increasing number of older people, many developed countries have, in recent decades, decentralised their health systems (Saltman & Bankauskaite, 2006). However, it has been argued that decentralisation contributes to a severe risk of fragmentation (Åhgren, 2007) and it could be difficult for older people to orientate within a fragmented health system.…”

Effects of health care decentralization in Spain from a citizens’ perspective

“…3 Nevertheless, we have to keep in mind that the bulk of the decentralization process occurred in 2002. 4 See, among many others, the collective work of Saltman et al (2007), the reviews of Jiménez-Rubio (2010) andandKolehmainen-Aitken (2005), the works of Bossert et al (2003) and Arreondo and Orozco (2005) for Latin American countries, the analyses of some African experiences by Jepsson and Okuonzi (2000) and Akin et al (2005), Tang and Bloom (2000) on China, Jiménez-Rubio et al (2008) and Zhong (2010) on Canada, Ferrario and Zanardi (2011) on Italy and Cantarero and Pascual (2006) on European Union countries.…”