Federalism and Decentralization in the Health Care Sector by Gregory P. Marchildon and Thomas J. Bossert published by Forum of Federations (2018).
“Health care is one of the most financially onerous and contested social policy responsibilities of governments in the early 21st century. In the summer of 2011, we were asked by the Forum of Federations to conduct a multi-country study on federalism and decentralization in the governance, financing, administration or delivery of health care. Our contributors examined Switzerland, Canada, Germany, Pakistan, South Africa, Brazil, Mexico and Nigeria. This particular selection offered a good range of different approaches to federalism and health system decentralization upon which to draw policy lessons and for those latter understudied countries, a base line for future scholarly investigation. We developed a detailed, common template based on a comparative policy methodology developed by Rose (2005) and the use of decision space analysis as originally proposed by Bossert (1998) and as subsequently developed in the health systems literature (Roman et al. 2017). While most conceptual frameworks on decentralization tend to privilege structure, we used a decision space analysis that allowed us to evaluate the implementation and ongoing management – the practices on the ground – of any health system. In each federation, authors identified and described five structural features comparable across jurisdictions: 1) the assignment of constitutional responsibility for health and healthcare; 2) the existence (or not) of a national law on healthcare establishing rights and responsibilities; 3) the sources of revenue directed to public sector health care and the public and private sources and proportion of financing; 4) the funding and budgeting process of the central government’s health ministry relative to that of the subnational governments; and 5) the organization and governance of the publicly financed or subsidized part of the health system .”
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