Publisher Description

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 Careis a valuable resource for those studying health care policy in federal systems and especially those interested in comparative aspects of the topic.

Author Biography

Gregory P. Marchildon is a professor emeritus at the Institute of Health Policy, Management, and Evaluation at the University of Toronto and the founding director of the North American Observatory on Health Systems and Policies.Thomas J. Bossert is a senior lecturer and the Director of the International Health Systems Program of the Harvard T.H. Chan School of Public Health.

Table of Contents

An Introduction to Federalism and Decentralization in Health CareSwitzerland: Subnational Authority and Decentralized Health CareHealth Care in Canada: Interdependence and IndependenceGermany: The Increasing Centralization of the Health Care SectorPakistan: Extreme DecentralizationHealth Care in South Africa: Interdependence and IndependenceBrazil: Local Government Role in Health CareDecentralization of Health Policy and Services in MexicoFederalism and the Health System in NigeriaFederalism and Decentralization in the Health Sector: An Overview of Eight Cases

Review

"In providing a systematic and comprehensive description of health system decentralization in eight different countries, Federalism and Decentralization in Health Care achieves an ambitious goal, and will be of interest to scholars of both health policy and federalism. This book provides a snapshot of both federal and health policy institutions in a wide variety of cases, and uses a framework that makes them comparable."--Katherine Boothe, Department of Political Science, McMaster University

Long Description

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.

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