Post on 19-Jan-2016
DecentralizationIntroduction
Richard B. SaltmanEmory University and
European Observatory on Health Systems and Policies
Visiting Professor, LSE Health1
Many Thanks
• Higher Education Innovation Fund, Department of Business, Schools and Innovation
• LSE Health/NHS Confederation Rachel Irwin, co-ordinator at LSE Stephen Groombridge and Michael Wood, co-co-ordinators at NHS Confederation
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Thinking about Decentralization I
(from European Observatory 2007 book)Decentralization is:• an “area” or a “zone” of activity, rather than a
single strategy• an “umbrella concept” with multiple, often
conflicting interpretations and perspectives
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Thinking about Decentralization II
• Decentralization has three “functional dimensions”:
- Political (policy/strategy) - Administrative (operational management) - Fiscal (raising funds/financial management)
These overlap and often conflict with each other
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Thinking about Decentralization III
Two broad arguments in favor of decentralization:
- “democratizing” argument: “closer to the people” - “efficiency” argument create competition and choice between local public units
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Thinking about Decentralization IV
Rise of Re-centralization in Europe: - re-centralizing political decision-making - re-centralizing fiscal control over funding - consolidating administrative decisions
Rejecting Decentralization?Sharing authority across different levels of
government?
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Our Distinguished Presenters
• Jeni Bremner, Director, European Healthcare Management Association, Brussels
• Antonio Duran, Principal, Tecsalud, Seville, Spain
• Jon Magnussen, Professor, Norwegian University of Science and Technology
• Scott Greer, Assistant Professor, University of Michigan, USA; Visiting Fellow, LSE Health
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