Conclusions

Abstract

Health systems throughout Europe often allocate power and resources over health policy to local and regional levels of government. However, rather than a single model of decentralization, we find a heterogeneous array of models that reflect very different political, historical, and policy logics This book has tried to bring together theoretical and empirical questions about decentralization, examining the implications of various models. This includes whether the state structure is formally federal or unitary, and whether decentralization is down to local, provincial regional or state level. Similarly, decentralization will take different shapes depending on how the health system is funded, given that funding is the ultimate source of legitimacy of public services. This conclusion will use evidence from the book chapters to respond to the three questions articulated at the beginning: what is decentralization, why do countries adopt a decentralized allocation of authority, and what do its effects appear to be?