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Federalism and Decentralization in Health Care: A Decision Space Approach

Edited by Gregory P. Marchildon and Thomas J. Bossert

© 2018

While health system decentralization is often associated with federations, there has been limited study on the connection between federalism and the organization of publicly financed or mandated health services. Federalism and Decentralization in Health Care examines eight federations that differ in terms of their geography, history and constitutional and political development. Looking at Canada, Brazil, Germany, Mexico, Nigeria, Pakistan, South Africa and Switzerland, Federalism and Decentralization in Health Care examines constitutional responsibility for health care, the national laws establishing a right to health care, the predominant sources and organization of public revenues directed to health care, and the overall organization of the health system.

In additional to these structural features, each country case study is subjected to a "decision space analysis" to determine the actual degree of health system decentralization. This involves determining whether national and subnational governments have narrow, moderate or broad discretion in their decisions on governance, access, human resources, health system organization and financing. This comparative approach highlights the similarities and differences among these federations. Offering reflections on recent trends in centralization or decentralizations for the health system as a whole, Federalism and Decentralization in Health Care, is a valuable resource for those studying health care policy in federal systems and especially those interested in comparative aspects of the topic.

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Product Details

  • Division: Scholarly Publishing
  • World Rights
  • Page Count: 272 pages
  • Dimensions: 6.0in x 0.7in x 9.0in
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  • PUBLISHED MAR 2018

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Looking at Canada, Brazil, Germany, Mexico, Nigeria, Pakistan, South Africa and Switzerland, Federalism and Decentralization in Health Care examines the overall organization of the health system.

Federalism and Decentralization in Health Care: A Decision Space Approach

Edited by Gregory P. Marchildon and Thomas J. Bossert

© 2018

While health system decentralization is often associated with federations, there has been limited study on the connection between federalism and the organization of publicly financed or mandated health services. Federalism and Decentralization in Health Care examines eight federations that differ in terms of their geography, history and constitutional and political development. Looking at Canada, Brazil, Germany, Mexico, Nigeria, Pakistan, South Africa and Switzerland, Federalism and Decentralization in Health Care examines constitutional responsibility for health care, the national laws establishing a right to health care, the predominant sources and organization of public revenues directed to health care, and the overall organization of the health system.

In additional to these structural features, each country case study is subjected to a "decision space analysis" to determine the actual degree of health system decentralization. This involves determining whether national and subnational governments have narrow, moderate or broad discretion in their decisions on governance, access, human resources, health system organization and financing. This comparative approach highlights the similarities and differences among these federations. Offering reflections on recent trends in centralization or decentralizations for the health system as a whole, Federalism and Decentralization in Health Care, is a valuable resource for those studying health care policy in federal systems and especially those interested in comparative aspects of the topic.

Continue Reading Read Less

Product Details

  • Division: Scholarly Publishing
  • World Rights
  • Page Count: 272 pages
  • Dimensions: 6.0in x 0.7in x 9.0in

  • Reviews

    "In providing a systematic and comprehensive description of health system decentralization in eight different countries, Federalism and Decentralization in Health Care achieves an ambitious goal, and will be of interest to scholars of both health policy and federalism. This book provides a snapshot of both federal and health policy institutions in a wide variety of cases, and uses a framework that makes them comparable."


    Katherine Boothe, Department of Political Science, McMaster University

  • Author Information

    Gregory P. Marchildon is Professor and Ontario Research Chair in Health Policy and System Design at the Institute of Health Policy, Management and Evaluation, University of Toronto.


    Thomas J. Bossert is a senior lecturer and the Director of the International Health Systems Program of the Harvard T.H. Chan School of Public Health.

  • Table of contents

    1. An Introduction to Federalism and Decentralization in Health Care
    2. Switzerland: Subnational Authority and Decentralized Health Care
    3. Health Care in Canada: Interdependence and Independence
    4. Germany: The Increasing Centralization of the Health Care Sector
    5. Pakistan: Extreme Decentralization
    6. Health Care in South Africa: Interdependence and Independence
    7. Brazil: Local Government Role in Health Care
    8. Decentralization of Health Policy and Services in Mexico
    9. Federalism and the Health System in Nigeria
    10. Federalism and Decentralization in the Health Sector: An Overview of Eight Cases

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