Saltman Richard B, Bankauskaite Vaida
European Observatory on Health Systems and Policies, and Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Health Econ Policy Law. 2006 Apr;1(Pt 2):127-47. doi: 10.1017/S1744133105001209.
Although decentralization has been widely implemented in health systems, there is little agreement as to how it should be defined or the outcomes it should produce. This article develops a functional typology based on political, administrative, and fiscal dimensions of decentralization. It utilizes these three categories to identify and highlight key theoretical issues concerning decentralization, emphasizing the likely advantages and disadvantages that decentralization can be expected to generate. It then examines the usefulness of this functional framework in explaining recent policy-making decisions within a number of tax-based health systems in Western Europe. The article concludes by suggesting that this three-part typology can be helpful to both policy makers and academics in evaluating the effectiveness of decentralization as a policy mechanism within health care systems.
尽管权力下放已在卫生系统中广泛实施，但对于应如何定义权力下放或其应产生的结果，却几乎没有共识。本文基于权力下放的政治、行政和财政维度，构建了一种功能类型学。它利用这三个类别来识别和突出有关权力下放的关键理论问题，强调权力下放可能产生的利弊。然后，本文考察了这一功能框架在解释西欧一些基于税收的卫生系统近期决策方面的有用性。文章最后指出，这种三部分的类型学有助于政策制定者和学者评估权力下放作为卫生保健系统政策机制的有效性。
