The European Observatory of Health Systems and Policies has just published its Study Series 29 which looks at the changing role of national governments in the governance of the health system.
This study of 12 countries provides an overview of recent changes in national governments’ role in the governance of health systems, focusing on efforts to reconfigure responsibilities for health policy, regulation and management; the resultant policy priorities; and the initial impact. The shift in responsibilities shows little uniform direction: a number of countries have centralized certain areas of decision-making or regulation but decentralized others. The study reviews common trends, based on the country cases, and assesses potential future developments.Executive summary
This study provides an overview of recent changes in the national government’s role in the governance of the health systems in 12 countries. Country assessments focus on recent efforts to reconfigure responsibilities for health policy, regulation and management; the resultant policy priorities; and the initial impact. The assessment also reflects current debate in order to provide a perspective for potential changes in future governance arrangements. A short review of common trends is based on the country cases.
The study was conducted by the European Observatory on Health Systems and Policies at the request of the Swedish Ministry of Health and Social Affairs. The methodology facilitated a rapid response to this request – conducted through a combination of reviews of recent Observatory publications followed by telephone interviews with key experts in each survey country. However, the study should be interpreted as only an initial assessment of ongoing and wide-ranging changes in health sector governance arrangements in Europe and beyond.
The changes in governance arrangements in the countries studied involve a wide range of measures but show no clear uniform direction for the resulting shifts in responsibilities. In a number of countries, recent reforms have centralized certain areas of decision-making or regulation but decentralized others – although the former has been more prevalent. Central governments have been seeking greater control of decision-making in countries with traditionally decentralized decision-making structures (including Australia, Denmark, Finland, Germany, Italy, Norway and Sweden). One core objective for the extension of central government authority is better alignment of subnational health administrations and other health actors towards common strategies, visions and national objectives. These new approaches often seek better targeting of increasingly constrained human and financial resources. Arguably, a smaller number of the reviewed countries have been pursuing a more collaborative approach. Spain (until summer 2012) has relied on various
cooperative mechanisms to tackle problems in the level, and the uneven distribution, of health care financing and provision that reflect the strong role of its 17 regions. France has increased the regions’ remit for strategic health services planning. Switzerland is reinforcing the role of the cantons in some
policy areas related to insurance and care provision and is re-emphasizing market conditions amongst insurers. However, the central government is also strengthening both the monitoring of private insurers and the coordination of standards for quality of care and disease prevention. Some countries also have sought to simplify their governance structures by merging health insurers (Germany) or regional and local governmental structures (Denmark, England, Finland). The Netherlands has placed health insurers in the driving seat for many decisions related to the financing and provision of care."
http://www.euro.who.int/en/what-we-publish/abstracts/changing-national-role-in-health-system-governance-the.-a-case-based-study-of-11-european-countries-and-australia
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