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Conceptualizing decentralization in European health systems: a functional perspective

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  • Saltman, Richard B.
  • Bankauskaite, Vaida

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.

Suggested Citation

  • Saltman, Richard B. & Bankauskaite, Vaida, 2006. "Conceptualizing decentralization in European health systems: a functional perspective," Health Economics, Policy and Law, Cambridge University Press, vol. 1(2), pages 127-147, April.
    • Handle: RePEc:cup:hecopl:v:1:y:2006:i:02:p:127-147_00
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    Cited by:

    1. Sumah, Anthony Mwinkaara & Baatiema, Leonard & Abimbola, Seye, 2016. "The impacts of decentralisation on health-related equity: A systematic review of the evidence," Health Policy, Elsevier, vol. 120(10), pages 1183-1192.
    2. Dubas-Jakóbczyk, Katarzyna & Domagała, Alicja & Zabdyr-Jamróz, Michał & Kowalska-Bobko, Iwona & Sowada, Christoph, 2023. "The 2021 plan for hospital care centralization in Poland – When politics overwhelms the policy process," Health Policy, Elsevier, vol. 129(C).
    3. Bosa, Iris & Castelli, Adriana & Castelli, Michele & Ciani, Oriani & Compagni, Amelia & Galizzi, Matteo M. & Garofano, Matteo & Ghislandi, Simone & Giannoni, Margherita & Marini, Giorgia & Vainieri, M, 2021. "Corona-regionalism? Differences in regional responses to COVID-19 in Italy," Health Policy, Elsevier, vol. 125(9), pages 1179-1187.
    4. Kroezen, Marieke & Dussault, Gilles & Craveiro, Isabel & Dieleman, Marjolein & Jansen, Christel & Buchan, James & Barriball, Louise & Rafferty, Anne Marie & Bremner, Jeni & Sermeus, Walter, 2015. "Recruitment and retention of health professionals across Europe: A literature review and multiple case study research," Health Policy, Elsevier, vol. 119(12), pages 1517-1528.
    5. Espinosa-González, Ana Belén & Delaney, Brendan C. & Marti, Joachim & Darzi, Ara, 2021. "The role of the state in financing and regulating primary care in Europe: a taxonomy," Health Policy, Elsevier, vol. 125(2), pages 168-176.
    6. Niccol? Persiani & Martina Giusti & Maria Jose Caldes & Afef Hagi, 2022. "Il contributo del management alla definizione della strategia di decentramento del Servizio Sanitario: il caso del Servizio Sanitario Tunisino," MECOSAN, FrancoAngeli Editore, vol. 2022(122), pages 85-103.
    7. Tediosi, Fabrizio & Gabriele, Stefania & Longo, Francesco, 2009. "Governing decentralization in health care under tough budget constraint: What can we learn from the Italian experience?," Health Policy, Elsevier, vol. 90(2-3), pages 303-312, May.
    8. Carlota Quintal, 2009. "Aversion to geographic inequality and geographic variation in preferences in the context of healthcare," Applied Health Economics and Health Policy, Springer, vol. 7(2), pages 121-136, June.
    9. Antonio Nuzzo & Flavia Carle & Eugenio Anessi Pessina, 2018. "Processo di decentramento del SSN ed evoluzione dell?equit? interregionale nell?assistenza sanitaria nel periodo 2001-2012," MECOSAN, FrancoAngeli Editore, vol. 2018(108), pages 9-34.
    10. Gorgemans, Sophie & Urbina-Pérez, Olga, 2022. "New legal forms in health services: Evaluation of a Spanish public policy," Health Policy, Elsevier, vol. 126(8), pages 802-807.
    11. Ryota Nakatani & Qianqian Zhang & Isaura Garcia Valdes, 2024. "Health Expenditure Decentralization and Health Outcomes: The Importance of Governance," Publius: The Journal of Federalism, CSF Associates Inc., vol. 54(1), pages 59-87.
    12. Alexandre Morais Nunes & Diogo Cunha Ferreira, 2022. "A Critical Analysis of Decentralizing the Portuguese Public Healthcare Provision Services," IJERPH, MDPI, vol. 19(20), pages 1-10, October.

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