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Related Experiment Video

Updated: Sep 20, 2025

Use of Principal Components for Scaling Up Topographic Models to Map Soil Redistribution and Soil Organic Carbon
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Decentralization Can Improve Equity, but Can It Be Sustained?

Thomas J Bossert1, Rony Lenz2, Ramiro Guerrero3

  • 1Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Health Systems and Reform
|June 6, 2022
PubMed
Summary

Decentralization in health systems can improve funding equity. Sustaining these reforms requires retaining per capita allocation rules and addressing wealthier municipalities' increased local funding.

Keywords:
ChileColombiadecentralizationequitysustainability

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Area of Science:

  • Health Policy and Management
  • Public Finance
  • Health Economics

Background:

  • Decentralization is a key health system reform strategy.
  • A primary concern is whether decentralization promotes equitable health system funding.
  • Previous research indicated improved equity under specific conditions in Colombia and Chile.

Purpose of the Study:

  • To assess the long-term sustainability of decentralized health system funding equity.
  • To examine the impact of changing allocation rules on funding equity over time.
  • To identify factors influencing the maintenance or erosion of health funding equity.

Main Methods:

  • Follow-up study conducted in 2015, building on 2003 research.
  • Analysis of national allocations and intergovernmental transfer rules.
  • Examination of insurance funding sources and per capita allocation principles.

Main Results:

  • National allocation equity was sustained in 2015, provided per capita allocation rules were maintained.
  • Changes in intergovernmental transfer and insurance funding rules did not negate equity.
  • Wealthier municipalities in Chile increased self-funding, widening the gap with poorer municipalities.

Conclusions:

  • Sustaining health funding equity requires consistent application of per capita allocation rules.
  • Policies addressing increased local funding by wealthier areas are necessary for continued equity.
  • Embedding reforms within financial systems and securing support from existing stakeholders enhances sustainability.