Do individuals’ health preferences validate the decentralisation of the public health system in Spain?

Sigüenza, Waleska; Artabe, Alaitz

doi:10.1016/j.healthpol.2022.04.010

Cited by 1 publication

(1 citation statement)

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“…This understanding is crucial in resource allocation, maximizing the overall well-being of the population [27]. Policymakers play a pivotal role in developing policies, and when the average cost of providing care aligns with population characteristics and healthcare structures, regions can enhance the efficiency of their healthcare system [26,66]. Thus, the aforementioned hypothesis was confirmed.…”

Section: Efficiencymentioning

confidence: 90%

The Impacts of Health Decentralization on Equity, Efficiency, and Effectiveness: A Scoping Review

Oliveira,

Santinha,

Sá Marques

2023

Sustainability

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Decentralization is considered an important component of participatory democracy. However, despite its widespread implementation in the healthcare sector, its impact on health systems’ performance remains unclear. Using a theoretical framework based on the World Health Organization’s five decentralization variables—geography and sociodemographics, organization of political processes, functions and economic weight, steering, and control—we conducted a scoping review to unveil causal mechanisms linking each feature to equity, efficiency, and effectiveness. Following the PRISMA protocol, 1627 articles were screened, and 63 were selected for data analysis, with a focus on middle- and high-income countries. The findings show that the most frequently discussed forms of decentralization are fiscal and administrative, with a primary focus on how governance mechanisms affect equity and efficiency. The effects of decentralized healthcare governance on equity, efficiency, and effectiveness are diverse and contingent on contextual factors and the implementation processes. The spatial context (geography) of decentralization negatively impacts equity, and steering strongly affects effectiveness. Functions and economic weight significantly influence efficiency, albeit with variability. Overall, decentralization falls short of delivering substantial healthcare system benefits, although this depends on contextual factors.

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Section: Efficiencymentioning

confidence: 90%