Decentralization
Introduction
Richard B. Saltman
Emory University and
European Observatory on Health
Systems and Policies
Visiting Professor, LSE Health
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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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