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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