Organisational innovations and health care decentralisation: A perspective from Spain
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- dc.contributor.author López, Guillem
- dc.contributor.other Universitat Pompeu Fabra. Departament d'Economia i Empresa
- dc.date.accessioned 2020-05-25T09:27:03Z
- dc.date.available 2020-05-25T09:27:03Z
- dc.date.issued 2006-11-01
- dc.date.modified 2020-05-25T09:21:32Z
- 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.format.mimetype application/pdf*
- dc.identifier https://econ-papers.upf.edu/ca/paper.php?id=984
- dc.identifier.citation Journal of Health Economics, Policy and Law, forthcoming
- dc.identifier.uri http://hdl.handle.net/10230/1239
- 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.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/es/
- 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.subject.keyword Labour, Public, Development and Health Economics
- dc.title Organisational innovations and health care decentralisation: A perspective from Spain
- dc.type info:eu-repo/semantics/workingPaper