Federalism and Decentralization in Health Care: A Decision Space Approach
Gregory P. Marchildon and Thomas J. Bossert
Even though 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, it explores vital health care issues such as constitutional responsibility, national laws, and the source and organization of public revenues.
Beyond these structural features, each country case system is subjected to a “decision space analysis” to determine the actual degree of decentralization. A core question is 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.