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This is the first book to examine the processes of territorial federalization and decentralization of health systems in Europe drawing from an interdisciplinary economics, public policy and political science approach. It contains key theoretical and empirical features that allow an understanding of when health care decentralization is successful.
Exploring the capacity and impact of decentralization within European health care systems, this book examines both the theoretical underpinnings as well as practical experience with decentralization.
This is the first book to examine the processes of territorial federalization and decentralization of health systems in Europe drawing from an interdisciplinary economics, public policy and political science approach. It contains key theoretical and empirical features that allow an understanding of when health care decentralization is successful.
How does fiscal decentralisation affect the development of a health system? Evidence from health care decentralisation in Europe can offer some insights to the question above. This paper addresses the effects of health care decentralisation in Europe, and reviews some of the key questions on the design of a health system. We argue that contrary to old mobility argument, the effects of health care decentralisation result from tighter political agency, which generally stands as an alternative to health care privatisation. However, whether efficiency improves after a process of decentralisation depends heavily on the incentives fiscal design exerts on cost -containment, inter-jurisdictional competition, policy innovation and diffusion. Experiences of health care decentralisation highlight important concerns associated with vertical imbalances and limited horizontal imbalances. Finally, health care decentralisation can give rise to a new regional political cycle where citizens can reward or penalise the performance of health policy.
While health system decentralization is often associated with federations, there has been limited study on the connection between federalism and the organization of publicly financed or mandated health services. Federalism and Decentralization in Health Care examines eight federations that differ in terms of their geography, history and constitutional and political development. Looking at Canada, Brazil, Germany, Mexico, Nigeria, Pakistan, South Africa and Switzerland, Federalism and Decentralization in Health Care examines constitutional responsibility for health care, the national laws establishing a right to health care, the predominant sources and organization of public revenues directed to health care, and the overall organization of the health system. In additional to these structural features, each country case study is subjected to a "decision space analysis" to determine the actual degree of health system decentralization. This involves determining whether national and subnational governments have narrow, moderate or broad discretion in their decisions on governance, access, human resources, health system organization and financing. This comparative approach highlights the similarities and differences among these federations. Offering reflections on recent trends in centralization or decentralizations for the health system as a whole, Federalism and Decentralization in Health Care, is a valuable resource for those studying health care policy in federal systems and especially those interested in comparative aspects of the topic.
This comprehensive scholarly book on comparative federalism and the Covid-19 pandemic is written by some of the world’s leading federal scholars and national experts. The Covid-19 pandemic presented an unprecedented emergency for countries worldwide, including all those with a federal or hybrid-federal system of government, which account for more than 40 per cent of the world’s population. With case studies from 19 federal countries, this book explores the core elements of federalism that came to the fore in combatting the pandemic: the division of responsibilities (disaster management, health care, social welfare, and education), the need for centralisation, and intergovernmental relations and cooperation. As the pandemic struck federal countries at roughly the same time, it provided a unique opportunity for comparative research on the question of how the various federal systems responded. The authors adopt a multidisciplinary approach to question whether federalism has been a help or a hindrance in tackling the pandemic. The value of the book lies in understanding how the Covid-19 pandemic affected federal dynamics and how it may have changed them, as well as providing useful lessons for how to combat such pandemics in federal countries in the future. This book will be of great interest to students and scholars of politics and international relations, comparative federalism, health care, and disaster management. The Open Access version of this book, available at http://www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license.
"The book is very valuable as actual information about the health systems in the Nordic countries and the changes that have been made during the last two decades. It informs well both about the similarities within the 'Nordic Health Model' and the important differences that exist between the countries." Bo Könberg, County Governor, Former Minister of Health and Social Insurance in Sweden (1991-94) "This book is a rich, interesting and very useful document. I have been looking, for example, today for precise information on political governing which is not displayed anywhere else. It will be of importance in many aspects!" Johan Calltorp MD PhD, Professor of Health Policy and Management, The Nordic School of Public Health, Gotenburg "The publishing of this book about the Nordic health care systems is a major event for those interested not only in Nordic health policy and health systems but also for everybody interested in comparative health policy and health systems. It is the first book in its kind. It covers the four 'large' Nordic countries, Denmark, Norway, Sweden and Finland, and does so in a very systematically comparative way. The book is well organized, covers 'everything' and is analytically sophisticated." Ole Berg, nstitute of Health Management and health economics, University of Oslo, Norway This book examines recent patterns of health reform in Nordic health care systems, and the balance between stability and change in how these systems have developed. The health systems in Norway, Denmark, Sweden and Finland are investigated through detailed comparisons along a variety of policy-driven parameters. The following themes are explored: Politicians, patients, and professions Financing, production, and distribution The role of the primary health sector The role of public health Internal management mechanisms Impact of the European Union The book probes the impact of these topics and then contrasts the development across all four, allowing the reader to gain a sense of perspective both on the individual countries as well as on the region as a whole. The editors also explore the extent to which a Nordic Health Care Model exists, and the degree to which that model will continue to help explain the future direction of health policy-making in these four countries. An additional chapter on recent developments in Iceland completes the work. Contributors: Tinna L. Ásgeirsdóttir, Paula Blomquist, Johan Calltorp, Terje P. Hagen, Unto Häkkinen, Peter K. Jespersen, Pia M. Jonsson, Lars Erik Kjekshus, Allan Krasnik, Meri Larivaara, Juhani Lehto, Kalevi Luoma, Jon Magnussen, Dorte S. Martinsen, Pål E. Martinussen, Bård Paulsen, Clas Rehnberg, Ånen Ringard, Richard B. Saltman, Signild Vallgårda, Karsten Vrangbæk, Ulrika Winblad, Sirpa Wrede.
The study of territorial politics has enjoyed a renaissance in the last thirty years. Scholars have questioned the state-centric assumptions upon which mainstream social science has been built, pointing to the territorial (re)distribution of power across and within states. This Handbook brings together leading scholars to demonstrate how territory has shaped institutional structures, public policies, elections, political parties, and identity across the world. Offering theoretical, comparative and empirical insights, this book provides a comprehensive overview of the impact of territory on modern political, economic and social life.
This book explores the dynamics of health system decentralization and recentralization, investigating why and how the territorial organization of health systems changes or remains stable over time. Drawing from historical and discursive institutionalism, the explanatory framework revolves around the role of ideas, discourse and institutions. Through the analysis of the Italian and Danish health systems, the book corroborates the value of combining ideational and institutional accounts in explaining institutional continuity and change, offering new empirical and theoretical insights into the study of public policy making. The book will be of use to students and scholars interested in health politics and policy, federalism and decentralization, and theories of institutional change.
Patient mobility across Europe is markedly increasing and new generations will actively ask to be treated by the health-care system that best meets their needs. At a political level, the EU issued the EU Directive no. 24/2011/CE of 9th March 2011 concerning the application of patients’ rights in cross-border health care and has contributed to improving the level of freedom of choice for the European citizen, but it does not seem to have increased actual patient mobility across Europe. Freedom to choose is necessary to grant the people of Europe the same access to public-sector health-care services. The latter is a key instrument for an efficiently functioning “single market” ensuring real mobility within the EU. The aim of this book is to study the current European health care market and discuss the hypothesis of a European right of citizenship with reference to health-care services. It examines patients' mobility from several perspectives: determinants of patient mobility, governance of cross-border mobility at EU level as concerns patients and health-care professionals, policy implications, and case studies. It is intended for health researchers, decision-makers and professionals concerned with health-care provision and patient mobility. The goal is to provide, through scientific and methodological rigor, new informative tools useful for the implementation of new policies in the health-care sector in order to implement effective health-care integration in the European Union.