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Health benefits from devolution in England: international lessons
Yvonne Doyle1, Paul Johnstone2
1London Division, Public Health England, London, UK European Centre on Health of Societies in Transition, London School of Hygiene & Tropical Medicine, London, UK.
Postgraduate Medical Journal
|February 25, 2016
Summary
Devolving health decision-making to English regions presents challenges. International evidence suggests mixed outcomes, with a need for robust evaluation frameworks to ensure equitable access and effective healthcare delivery.
Area of Science:
- Health policy
- Public health
- Health services research
Background:
- The UK government is devolving health decision-making power to 30 English regions.
- International evaluation of devolved health models is limited.
- Devolution aims to improve health outcomes and citizen engagement.
Purpose of the Study:
- To assess the potential of devolved health models to improve health outcomes.
- To review international evidence on the effectiveness of devolved health systems.
- To propose an evaluation framework for devolved health governance.
Main Methods:
- Systematic review of international evidence on devolved health systems.
- Analysis of factors contributing to successful and unsuccessful devolution.
- Development of a comprehensive evaluation framework.
Main Results:
- International outcomes of devolved health systems are mixed.
- Some evidence suggests increased efficiency in care delivery.
- Limited evidence of improved clinical outcomes or health status.
- Challenges exist in managing specialized services and ensuring equitable access.
Conclusions:
- Holistic approaches incorporating fiscal freedoms and citizen engagement are key.
- National regulation is crucial to prevent provider gaming.
- Robust evaluation frameworks are essential for ongoing governance and implementation.
- Further research and continuous evaluation are recommended for devolved health systems.
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