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Conceptualizing decentralization in European health systems: a functional perspective
Richard B Saltman1, Vaida Bankauskaite
1European Observatory on Health Systems and Policies, and Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. rsaltma@sph.emory.edu
Health Economics, Policy, and Law
|July 19, 2008
Summary
Decentralization in health systems lacks a clear definition and expected outcomes. This study proposes a functional typology to analyze its political, administrative, and fiscal dimensions, aiding policy evaluation.
Area of Science:
- Health Policy and Management
- Public Administration
- Political Science
Background:
- Decentralization is a common strategy in health systems globally.
- There is a lack of consensus on defining decentralization and its intended outcomes in healthcare.
- Existing frameworks may not adequately capture the multifaceted nature of health system decentralization.
Purpose of the Study:
- To develop a functional typology for analyzing health system decentralization.
- To identify theoretical issues, advantages, and disadvantages associated with decentralization.
- To assess the utility of this framework in understanding policy decisions in European health systems.
Main Methods:
- Development of a typology based on political, administrative, and fiscal dimensions.
- Theoretical analysis of decentralization's implications.
- Case study examination of policy-making in Western European tax-based health systems.
Main Results:
- A three-part functional typology (political, administrative, fiscal) for decentralization is proposed.
- The typology highlights key theoretical debates and potential benefits and drawbacks.
- The framework demonstrates utility in explaining policy choices in specific national contexts.
Conclusions:
- The proposed three-part typology offers a structured approach to understanding health system decentralization.
- This framework can assist policymakers and researchers in evaluating decentralization's effectiveness.
- Further application of the typology can refine our understanding of health system governance.
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