Political decentralization in health care

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Political decentralization in health care

• Minna Kaarakainen
• Researcher
• minna.kaarakainen_at_uku.fi

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Structure of the presentation

• Highlights from the results
• Background of the study
• Materials and methods

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Political decentralization - the concept

• Decentralization as a function of management is
  widely in use
• The concept can be diveded at least four levels
• administrative
• fiscal
• political
• market
• All levels have sublevels and are usually linked
  each other

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Political decentralization
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Political decentralization - the levels

• Means transform the the political power from
  central governtment to local government
• Usually needs legislative reform and creating
  local political units
• Can happen also inside the health care
  organization - municipal administrator delegate
  it's decision-making power of political decision
  making
• Questions of citizen rights once citizen has
  elected an official, can administrator pass it
  over to some one else?

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Finnish health care system

• has undergone an interesting development process
  moving from a centralized national welfare state
  to autonomous municipal services
• municipal primary care remains the foundation of
  the system- municipalities are obligated to
  organise primary health care for its citizens -
  extreme decentralized system

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Finnish health care system

• Municipalities can organise these services
• by themselves,
• with other municipalities or
• buying the services from the private sector
• Municipalities have serious problems in
  organizing the services - The Project "Paras" was
  launched in 2005 - aim is to restructure local
  government and services ? small size
  municipalities has to assimilate to the other
  municipalities ? political power will be
  centralized to larger units - what will happen to
  citizens rights?

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Materials and methods - historical perspective

• Content analysis of the political and legislative
  papers from 1945 to date
• 64 documents
• government platforms
• legistlation of health care
• legistlation of municipalties
• political papers

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Materials and methods - future perspective

• 2 phase Delphi-study
• 1st round in the autumn 2005 (N98, response rate
  71)
• 2nd round in the autumn 2006 (N89, response rate
  80)
• the panel consisted of
• elected officials of the municipalities
• primary care decision-makers
• 39 municipalities all over Finland

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Thank you for your attention!

• For further inquiries, please contact
• Minna Kaarakainen
• Department of Health Policy and Management
• University of Kuopio
• P.O.Box 1627
• FI-70211 Kuopio
• FINLAND
• Tel. [phone]
• email minna.kaarakainen_at_uku.fi