Is a Decentralised Health Policy Associated With Better Self-rated Health and Health Services Evaluation? A Comparative Study of European Countries.

Pål E. Martinussen,Håvard T. Rydland

doi:10.34172/ijhpm.2020.13

Abstract

Background: While decentralisation has come to be a major policy strategy in many healthcare systems, there is still insufficient evidence about its impact. Most studies have been of developing countries, and they have provided mixed results. This study is the first to test the relevance of political decentralisation across European countries, thus meeting the demand for more studies of decentralisation in developed countries, and building on an indicator of decentralisation reflecting the allocation of authority for both health policy tasks and health policy areas. Methods: As indicators of health system outcome, we employed 2 measures that have not previously been investigated in the context of decentralisation: self-rated health and satisfaction with healthcare system. Using multilevel modelling and controlling for individual-level demographic and socioeconomic variables, the paper utilised the 2014 (7th) and 2016 (8th) round of the European Social Survey (ESS), including more than 70 000 individuals from 20 countries. Results: The results suggest that decentralisation has a positive and significant association with health system satisfaction, but not with self-rated health. Of the different operationalisations, decentralised healthcare provision had the strongest association with health system satisfaction. Conclusions: Our study fails to provide clear support for decentralised health systems. There is a need for more research on the impact of such reforms in order to provide policy-makers with knowledge of desirable governance, organisational designs, management and incentives in healthcare.

Highlights

Decentralisation has become the buzzword of health policy over the last decades
The results indicate that no operationalisations of decentralisation had significant associations with respondents’ self-rated health (Tables 3 and 4)
The concept of decentralisation has emerged as a cornerstone of health policy reforms in many European countries.[2,3,4]

Summary

Introduction

Decentralisation has become the buzzword of health policy over the last decades. The term decentralisation refers to a wide variety of power transfer arrangements and accountability systems, but generally builds on the idea that smaller organisations are more responsive and accountable than larger organisations. Decentralisation is seen as a response to poor efficiency, slow innovation, and lack of responsiveness to patient’s demands, which may be some of the drawbacks of large, centralised public institutions. If properly designed and implemented, decentralisation is expected to improve equity, efficiency, quality, and access to healthcare services and health outcomes.[1] while decentralisation has come to be a major policy strategy in many healthcare systems,[2,3,4] there is still insufficient evidence about its impact.

Methods

Results

Discussion

Conclusion