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The Impacts of Health Decentralization on Equity, Efficiency, and Effectiveness: A Scoping Review

Author

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  • Rafaela Oliveira

    (Governance, Competitiveness and Public Policies Research Unit (GOVCOPP), Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal)

  • Gonçalo Santinha

    (Governance, Competitiveness and Public Policies Research Unit (GOVCOPP), Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal)

  • Teresa Sá Marques

    (Geography and Spatial Planning Research Centre (CEGOT), Department of Geography, Faculty of Arts and Humanities, University of Porto, 4150-564 Porto, Portugal)

Abstract

Decentralization is considered an important component of participatory democracy. However, despite its widespread implementation in the healthcare sector, its impact on health systems’ performance remains unclear. Using a theoretical framework based on the World Health Organization’s five decentralization variables—geography and sociodemographics, organization of political processes, functions and economic weight, steering, and control—we conducted a scoping review to unveil causal mechanisms linking each feature to equity, efficiency, and effectiveness. Following the PRISMA protocol, 1627 articles were screened, and 63 were selected for data analysis, with a focus on middle- and high-income countries. The findings show that the most frequently discussed forms of decentralization are fiscal and administrative, with a primary focus on how governance mechanisms affect equity and efficiency. The effects of decentralized healthcare governance on equity, efficiency, and effectiveness are diverse and contingent on contextual factors and the implementation processes. The spatial context (geography) of decentralization negatively impacts equity, and steering strongly affects effectiveness. Functions and economic weight significantly influence efficiency, albeit with variability. Overall, decentralization falls short of delivering substantial healthcare system benefits, although this depends on contextual factors.

Suggested Citation

  • Rafaela Oliveira & Gonçalo Santinha & Teresa Sá Marques, 2023. "The Impacts of Health Decentralization on Equity, Efficiency, and Effectiveness: A Scoping Review," Sustainability, MDPI, vol. 16(1), pages 1-32, December.
    • Handle: RePEc:gam:jsusta:v:16:y:2023:i:1:p:386-:d:1311528
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    References listed on IDEAS

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    1. Ilaria Mosca, 2007. "Decentralization as a determinant of health care expenditure: empirical analysis for OECD countries," Applied Economics Letters, Taylor & Francis Journals, vol. 14(7), pages 511-515.
    2. Aletras, Vassilios & Kontodimopoulos, Nick & Zagouldoudis, Athanasios & Niakas, Dimitris, 2007. "The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals," Health Policy, Elsevier, vol. 83(2-3), pages 236-245, October.
    3. Gökçe MANAVGAT & Ayhan DEMİRCİ, 2020. "Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey," Sosyoekonomi Journal, Sosyoekonomi Society, issue 28(44).
    4. Joan Costa-Font & Gilberto Turati, 2018. "Regional healthcare decentralization in unitary states: equal spending, equal satisfaction?," Regional Studies, Taylor & Francis Journals, vol. 52(7), pages 974-985, July.
    5. Charles M. Tiebout, 1956. "A Pure Theory of Local Expenditures," Journal of Political Economy, University of Chicago Press, vol. 64(5), pages 416-416.
    6. Margherita Giannoni & Theodore Hitiris, 2002. "The regional impact of health care expenditure: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 34(14), pages 1829-1836.
    7. Hao, Yu & Liu, Jiahui & Lu, Zhi-Nan & Shi, Ruijie & Wu, Haitao, 2021. "Impact of income inequality and fiscal decentralization on public health: Evidence from China," Economic Modelling, Elsevier, vol. 94(C), pages 934-944.
    8. Di Novi, Cinzia & Piacenza, Massimiliano & Robone, Silvana & Turati, Gilberto, 2019. "Does fiscal decentralization affect regional disparities in health? Quasi-experimental evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 78(C).
    9. Jean-Paul Faguet & Fabio Sánchez, 2014. "Decentralization and access to social services in Colombia," Public Choice, Springer, vol. 160(1), pages 227-249, July.
    10. Catarina Ianni Segatto & Daniel Béland, 2021. "Federalism and decision making in health care: the influence of subnational governments in Brazil," Policy Studies, Taylor & Francis Journals, vol. 42(3), pages 308-326, May.
    11. Tatchalerm Sudhipongpracha, 2013. "Measuring community empowerment as a process and an outcome: preliminary evaluation of the decentralized primary health care programs in northeast Thailand," Community Development, Taylor & Francis Journals, vol. 44(5), pages 551-566, December.
    12. Silvia Bruzzi & Enrico Ivaldi & Marta Santagata, 2022. "Measuring Regional Performance in the Italian NHS: Are Disparities Decreasing?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 159(3), pages 1057-1084, February.
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