Health System Federalism and Decentralization: What Is It, Why Does It Happen, and What Does It Do?

  • Joan Costa-Font
  • Scott L. Greer


Discussions of decentralization in health systems are ubiquitous, in politics and political economy, in economics, in health services, and in public policy. So is decentralization or territorial complexity in health policy and other areas of welfare responsibility, such as education and social care. It seems no country’s policy elites or scholars can quite stop debating the territorial organization of their government, public administration, and health services.They also decentralized more, starting in the 1970s in most cases. Its causes are much discussed, with diversity, democracy, and nationalism all playing clear roles (Hooghe et al. 2010; Loughlin et al. 2011; McEwen and Moreno 2005).


Social Care Veto Player Soft Budget Constraint Social Insurance System Social Citizenship 
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© Joan Costa-Font and Scott L. Greer 2013

Authors and Affiliations

  • Joan Costa-Font
  • Scott L. Greer

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