Decentralization in health care

by Saltman, Richard; Bankauskaite, Vaida; Vrangbaek, Karsten

• ISBN13: 9780335219254
• ISBN10: 033521925X
• Edition: 1st
• Format: Paperback
• Copyright: 2006-12-01
• Publisher: Open University Press

Summary

The term 'decentralization' is used to describe a wide variety of power transfer arrangements and accountability systems. Policies range from the transfer of limited powers to lower management levels within current health management structures and financing mechanisms to extensive sectoral reform efforts which reconfigure the provision of even the most basic services. In the first case, decentralization may later become the driving force for health sector reform; in the latter, it is driven by the wider sectoral reform efforts. The parameters for decentralization -- the speed, the pressures, and the scope of issues to consider -- vary considerably.Decentralization has become a popular management strategy in many European health care systems. This volume will explore the capacity and impact of decentralization within European health care systems. It will examine both the theoretical underpinnings as well as recent practical experience with decentralization, drawing upon both published literature as well as evidence collected directly from the field. The book will also assess the appropriateness inside health systems of the management process for implementing a successful decentralization strategy.

Table of Contents

Introduction : the question of decentralization	p. 1
Central issues in the decentralization debate	p. 9
Patterns of decentralization across European health, systems	p. 22
Towards a typology for decentralization in health care	p. 44
Key factors in assessing decentralization and recentralization in health systems	p. 63
Drawing lessons for policy-making	p. 77
Approaches to studying decentralization in health systems	p. 87
Effects of decentralization and recentralization on economic dimensions of health systems	p. 105
Effects of decentralization and recentralization on political dimensions of health systems	p. 120
Effects of decentralization on managerial dimensions of health systems	p. 141
Effects of decentralization on clinical dimensions of health systems	p. 167
Effects of decentralization and recentralization on equity dimensions of health systems	p. 189
Information strategies for decentralization	p. 206
Implementation of health care decentralization	p. 225
Privatization as decentralization strategy	p. 246
Description of the structure and development of decentralization in health care in selected countries in Europe and Canada	p. 272
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