Decentralization has long been advocated as a desirable process for improving health systems.
Nevertheless, we still lack a sufficient analytical framework for systematically studying how decentralization can achieve this objective.
We do not have adequate means of analyzing the three key elements of decentralization : (1) the amount of choice that is transferred from central institutions to institutions at the periphery of health systems, (2) what choices local officials make with their increased discretion and (3) what effect these choices have on the performance of the health system.
This article proposes a framework of analysis that can be used to design and evaluate the decentralization of health systems.
It starts from the assumption that decentralization is not an end in itself but rather should be designed and evaluated for its ability to achieve broader objectives of health reform : equity, efficiency, quality and financial soundness.
Using a principal agent approach as the basic framework, but incorporating insights from public administration, local public choice and social capital approaches, the article presents a decision space approach which defines decentralization in terms of the set of functions and degrees of choice that formally are transferred to local officials.
The approach also evaluates the incentives that central government can offer to local decision-makers to encourage them to achieve health objectives. (...)
Mots-clés Pascal : Système santé, Décentralisation, Organisation santé, Décision, Performance, Innovation, Politique sanitaire, Evaluation, Homme, Pays industrialisé
Mots-clés Pascal anglais : Health system, Decentralization, Public health organization, Decision, Performance, Innovation, Health policy, Evaluation, Human, Industrialized country
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0534447
Code Inist : 002B30A01B. Création : 23/03/1999.