Abstract
Decentralisation is a complex, yet basic feature of health care systems in many countries entailing the transfer of authority or dispersal of power in public planning, management and decision making from higher to lower levels of government. This paper describes the attempts made in Greece from 1923 until today to decentralise its highly centralised health care system, drawing on a thorough documentary analysis of legislative acts and official reports regarding regional health policy. The analysis shows that, although decentralisation has been attempted on several occasions, in the end it was abandoned every time. The first ever implementation of a decentralised system of governance in 2001 was also curtailed, resulting in only minor decentralisation of authority and real powers. It is suggested that decentralisation has been impeded by many factors, especially obstruction by opposition from key interest groups, absence of policy continuity between governments, the inability to tackle the bureaucratic and highly centralised system and lack of political will.
Highlights
Decentralisation as an organisational process has been high on the political agenda in many European health systems over the past decades, denoting a major shift in Europe in the relationship between national, regional, and local control over health sector decision-making
Decentralisation is a complex, yet basic feature of health care systems in many countries entailing the transfer of authority or dispersal of power in public planning, management and decision making from higher to lower levels of government
This paper describes the attempts made in Greece from 1923 until today to decentralise its highly centralised health care system, drawing on a thorough documentary analysis of legislative acts and official reports regarding regional health policy
Summary
Decentralisation as an organisational process has been high on the political agenda in many European health systems over the past decades, denoting a major shift in Europe in the relationship between national, regional, and local control over health sector decision-making. Since World War II, a central thrust of health policy has been to decentralise key dimensions of decision-making authority to increasingly lower levels of government or to Social Health Insurance bodies.In addition, by shifting services to private sector organisations (Saltman, Bankauskaite, & Vrangbaek, 2007), some tax-based systems are decentralising powers away from the state. The aim of the paper is to identify the attempts to decentralise the Greek health sector and, by use of documentary analysis, to examine the reasons why they have been abandoned. The legislation relating to the decentralisation of the Greek health care system will be reviewed from 1923 to today
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