Federalism and Decentralization in Health Care ― A Decision-space Approach

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.