Decentralisation in the Health Sector and Responsibilities Across Levels of Government

TARGET GROUP: LOCAL GOVERNMENTS

OBJECTIVES

·        To summarise the results of a recent OECD survey on responsibilities across decision makers and on performance systems in the health care sector.

·        To build an understanding of the roles of the different decision-making powers in the health sector. To provide an effective space for government officials to openly discuss challenges and solutions to the fiscal sustainability of health systems.

·       To present quantitative and qualitative information on the decentralised nature of health systems, mainly hospitals, and how the degree of decentralisation and spending power varies according to different institutional characteristics.

SUMMARY

Decentralisation is a fundamental characteristic of many health systems, with subnational governments often responsible for the delivery and financing of health services. But the degree of decentralisation varies markedly across OECD countries. Although it can be a result of historical context, for example the influence of federal or unitary systems, decentralisation is often caused by the need of central government to alleviate budget pressures (OECD, 2015[1]). Decentralisation of the health system may also be viewed as a mechanism to improve health outcomes, through stimulating efficiency or providing a more focused set of health care services based on need. This paper builds on a literature review that was presented at the 2017 meeting of the Network on Fiscal Relations across Levels of Government (Phillips, 2018[2]).

REFERENCE: 

https://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?cote=COM/DELSA/GOV(2019)2&docLanguage=En