LIST OF PANELS

Striking the right balance between centralization and decentralization in health systems has been on the agenda for a number of years (Saltman et al 2007, Pollitt 2007, Greer 2016, Marchildon and Bossert 2018). The debate is relevant in all health systems including federalist states such as Canada, Germany and Spain and unitary states in the Nordic region.  The core of the debate is how to balance a variety of governance objectives with developments in technology and practices of health care delivery. Specific health related issues include the determination of optimal unit sizes given the population health care needs and the advances in technology and professional practice. Aging populations and growing numbers of people with chronic care needs may lead to strategies of decentralization to local communities. Advances in telemedicine can support this process. On the other hand, innovations in sophisticated diagnostic and treatment technology may require centralization as they need a high level of professional expertise and larger populations to be clinically and economically viable.

However, (de)centralization debates also involve political issues about the balance between various societal objectives and governance concerns. And decisions about (de)centralization have implications for power and accountability structures, and for the local economy and sense of security.

Centralization is often associated with benefits of scale, tighter economic control, better coordination, clearer accountability relationships, and the ability to impose geographical equity as well as develop and enforce standards (Pollitt 2007).  In contrast, decentralization is often seen as a vehicle for achieving operative efficiency through higher agility in decision processes and better adjustment to local conditions and preferences. Other arguments for decentralization include the opportunity for competition for personnel and investments, and a more transparent link between service levels and taxation. Taken together this can lead to more local level innovation. Decentralization is also seen as a way to promote democratic participation and accountability due to shorter principal-agent relationships and more transparency. Democratic participation tends to strengthen legitimacy and can serve as education for aspiring politicians. Finally, in some countries, decentralization can be a relevant and necessary strategy to handle internal tensions, including secessionist movements, and avoid disintegration (Greer 2016; Marchildon and Bossert 2018).

In sum, the tension between centralization and decentralization in health care touches upon a number of core concepts and debates in public policy studies. This panel aims to explore historical and recent developments in the dynamics of health policy in regards to (de)centralization of health systems and organizations. We invite studies of policy processes leading to (de)centralization reforms including the aims and political dynamics behind the reforms. Secondly, we want to focus on the governance tools that are used to achieve vertical and horizontal coordination in different health systems. We want to explore the configuration of multi-level governance in different health care systems and to look at evidence for benefits and drawbacks of different arrangements.
 
References:

· Saltman, RB, Bankauskaite, V & Vrangbæk, K (eds) 2007, Decentralization in Health Care: Strategies and outcomes. European Observatory on Helath Systems and Policies Series, McGraw-Hill, Maidenhead & New York.
· Pollitt, C. (2007). Decentralization: A Central Concept in Contemporary Public Management. I: Ewan Ferlie, Laurence E. Lynn Jr., and Christopher Pollitt: The Oxford Handbook of Public Management. Oxford University Press. (pp.371-397). in the Oxford Handbook of Public Management.
· Greer, S. (2016). Intergovernmental governance for health: federalism, decentralization and communicable diseases. In Greer, S. L., Wismar, M., Figueras, J. (2016). Strengthening Health System Governance. Better policies, stronger performance. Open University Press. McGraw-Hill Education. Maidenhead Berkshire England.
· Marchildon, GP, & Bossert TJ (eds) 2018. Federalism and Decentralization in Health Care: A Decision Space Approach. Toronto: University of Toronto Press.

Striking the right balance between centralization and decentralization in health systems has been on the agenda for a number of years (Saltman et al 2007, Pollitt 2007, Greer 2016, Marchildon and Bossert 2018). The debate is relevant in all health systems including federalist states such as Canada, Germany and Spain and unitary states in the Nordic region. The core of the debate is how to balance a variety of governance objectives with developments in technology and practices of health care delivery. Specific health related issues include the determination of optimal unit sizes given the population health care needs and the advances in technology and professional practice. Aging populations and growing numbers of people with chronic care needs may lead to strategies of decentralization to local communities. Advances in telemedicine can support this process. On the other hand, innovations in sophisticated diagnostic and treatment technology may require centralization as they need a high level of professional expertise and larger populations to be clinically and economically viable.

However, (de)centralization debates also involve political issues about the balance between various societal objectives and governance concerns. And decisions about (de)centralization have implications for power and accountability structures, and for the local economy and sense of security.

Centralization is often associated with benefits of scale, tighter economic control, better coordination, clearer accountability relationships, and the ability to impose geographical equity as well as develop and enforce standards (Pollitt 2007). In contrast, decentralization is often seen as a vehicle for achieving operative efficiency through higher agility in decision processes and better adjustment to local conditions and preferences. Other arguments for decentralization include the opportunity for competition for personnel and investments, and a more transparent link between service levels and taxation. Taken together this can lead to more local level innovation. Decentralization is also seen as a way to promote democratic participation and accountability due to shorter principal-agent relationships and more transparency. Democratic participation tends to strengthen legitimacy and can serve as education for aspiring politicians. Finally, in some countries, decentralization can be a relevant and necessary strategy to handle internal tensions, including secessionist movements, and avoid disintegration (Greer 2016; Marchildon and Bossert 2018).

In sum, the tension between centralization and decentralization in health care touches upon a number of core concepts and debates in public policy studies. This panel aims to explore historical and recent developments in the dynamics of health policy in regards to (de)centralization of health systems and organizations. We invite studies of policy processes leading to (de)centralization reforms including the aims and political dynamics behind the reforms. Secondly, we want to focus on the governance tools that are used to achieve vertical and horizontal coordination in different health systems. We want to explore the configuration of multi-level governance in different health care systems and to look at evidence for benefits and drawbacks of different arrangements.