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Geographically-decentralized planning and management in health care: Some informational issues and their implications for efficiency


  • Hurley, Jeremiah
  • Birch, Stephen
  • Eyles, John


Geographically decentralized planning and management is an emerging theme within the health sector in many OECD countries. Advocates of decentralization argue that providing greater authority to local decision-making bodies can improve both the technical and allocative efficiency with which health care systems operate. Using concepts drawn from organizational theory and the economics of organizations, we examine the potential of centralized and decentralized planning and management structures to be efficient in light of the informational problems that must be overcome to allocate resources efficiently. We focus in particular on the need to integrate information regarding: (1) the effectiveness and efficiency of alternative clinical interventions and of alternative ways organize the delivery of health care; (2) the needs, values, and preferences in the population; and (3) local circumstances that affect delivery of care across regions. Informational concerns suggest that decentralized structures have greater potential to be efficient. We then briefly discuss some principles for the design of decentralized structures to aid in realizing these potential efficiency gains.

Suggested Citation

  • Hurley, Jeremiah & Birch, Stephen & Eyles, John, 1995. "Geographically-decentralized planning and management in health care: Some informational issues and their implications for efficiency," Social Science & Medicine, Elsevier, vol. 41(1), pages 3-11, July.
  • Handle: RePEc:eee:socmed:v:41:y:1995:i:1:p:3-11

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    Cited by:

    1. Ross Barnett, J. & Pearce, Jamie & Howes, Pamela, 2006. "'Help, educate, encourage?': Geographical variations in the provision and utilisation of diabetes education in New Zealand," Social Science & Medicine, Elsevier, vol. 63(5), pages 1328-1343, September.
    2. Khaleghian, Peyvand & Das Gupta Monica, 2004. "Public management and essential public health functions," Policy Research Working Paper Series 3220, The World Bank.
    3. Khaleghian, Peyvand & Gupta, Monica Das, 2005. "Public management and the essential public health functions," World Development, Elsevier, vol. 33(7), pages 1083-1099, July.
    4. Abelson, Julia & Forest, Pierre-Gerlier & Eyles, John & Casebeer, Ann & Martin, Elisabeth & Mackean, Gail, 2007. "Examining the role of context in the implementation of a deliberative public participation experiment: Results from a Canadian comparative study," Social Science & Medicine, Elsevier, vol. 64(10), pages 2115-2128, May.


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