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The European Journal of Public Health 2008 18(2):104-106; doi:10.1093/eurpub/ckn013
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© The Author 2008. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Viewpoint

Decentralization, re-centralization and future European health policy

Richard B. Saltman

Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA

Correspondence: e-mail: rsaltma@sph.emory.edu

The first 150 words of the full text of this article appear below.


   Decentralization as a strategic cornerstone
 
A major shift appears to be underway in Europe in the relationship between national, regional, and local control over health sector decision-making. Since World War II, a central thrust of health policy has been to decentralize key dimensions of decision-making authority to increasingly lower levels of government, as well as (in Social Health Insurance systems and recently in some tax-based systems) to private sector organizations.1 This strategy, to adapt Kondratiev's business-cycle framework,2 has been one of two overlapping ‘long waves’ that helped frame structural decisions in most Western European health systems. The second wave—market-influenced-entrepreneurialism—has run simultaneously with decentralization since the late 1980s. However, while this second, market-oriented wave has generated considerable controversy in some health policy circles, the concept of decentralization was readily accepted in many national policy contexts. As a result, over the second half of the 20th century, expanded decentralization of authority to regional, municipal and non-governmental control . . . [Full Text of this Article]


   The rise of re-centralization
 

   Reasons for re-centralizing
 

   Re-centralization—the next "long wave"?
 

   Initial conclusions
 

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