Organisational innovations and health care decentralisation: A perspective from Spain

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Journal of Health Economics, Policy and Law, forthcoming
http://hdl.handle.net/10230/1239
To cite or link this document: http://hdl.handle.net/10230/1239
dc.contributor.author López, Guillem
dc.contributor.other Universitat Pompeu Fabra. Departament d'Economia i Empresa
dc.date.issued 2006-11-01
dc.identifier.citation Journal of Health Economics, Policy and Law, forthcoming
dc.identifier.uri http://hdl.handle.net/10230/1239
dc.description.abstract Recent policy developments in public health care systems lead to a greater diversity in health care. Decentralisation, either geographically or at an institutional level, is the key force, because it encourages innovation and local initiatives in health care provision. The devolution of responsibilities allows for a sort of ‘de-construction’ of the status quo by changing both organizational forms and service provision. The new organizations enjoy greater freedom in the way they pay their staff, and are judged according to their results. These organizations may retain financial surpluses, develop ‘spin-off’ companies and commission a range of specialised services (such as Diagnostic and Treatment Centres in UK) from providers outside the institutional setting in order to have more access to capital markets. However this diversity may generate a feeling of lack of commitment to a national health service and ultimately a loss of social cohesion. By fiscal decentralisation to regional authorities or planned delegation of financial agreements to the providers, financial incentives are more explicit and may seem to place profit-making above a commitment to better health care. An evaluation of the ‘myths and realities’ of the decentralization process is needed. Here, I offer an assessment ‘pros’ and ‘cons’of the decentralization process of health care in Spain, drawing on the experience of regional reforms from the pioneering organisational innovations implemented in Catalonia in 1981, up to the observed dispersion of health care spending per capita among regions at present.
dc.language.iso eng
dc.relation.ispartofseries Economics and Business Working Papers Series; 984
dc.rights L'accés als continguts d'aquest document queda condicionat a l'acceptació de les condicions d'ús establertes per la següent llicència Creative Commons
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/es/
dc.title Organisational innovations and health care decentralisation: A perspective from Spain
dc.type info:eu-repo/semantics/workingPaper
dc.date.modified 2014-06-03T07:14:18Z
dc.subject.keyword Labour, Public, Development and Health Economics
dc.subject.keyword fiscal decentralisation
dc.subject.keyword management autonomy
dc.subject.keyword hospital innovation
dc.subject.keyword national health system
dc.subject.keyword spain
dc.subject.keyword regional health service
dc.subject.keyword catalonia
dc.rights.accessRights info:eu-repo/semantics/openAccess


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