Decentralization Introduction Richard B. Saltman Emory University and European Observatory on Health Systems and Policies Visiting Professor, LSE Health 1

Many Thanks Higher Education Innovation Fund, Department of Business, Schools and Innovation LSE Health/NHS Confederation Rachel Irwin, co-ordinator at LSE Stephen Groombridge and Michael Wood, co-co-ordinators at NHS Confederation 2

Thinking about Decentralization I (from European Observatory 2007 book) Decentralization is: an “area” or a “zone” of activity, rather than a single strategy an “umbrella concept” with multiple, often conflicting interpretations and perspectives 3

Thinking about Decentralization II Decentralization has three “functional dimensions”: - Political (policy/strategy) - Administrative (operational management) - Fiscal (raising funds/financial management) These overlap and often conflict with each other 4

Thinking about Decentralization III Two broad arguments in favor of decentralization: - “democratizing” argument: “closer to the people” - “efficiency” argument create competition and choice between local public units 5

Thinking about Decentralization IV Rise of Re-centralization in Europe: - re-centralizing political decision-making - re-centralizing fiscal control over funding - consolidating administrative decisions Rejecting Decentralization? Sharing authority across different levels of government? 6

Our Distinguished Presenters Jeni Bremner, Director, European Healthcare Management Association, Brussels Antonio Duran, Principal, Tecsalud, Seville, Spain Jon Magnussen, Professor, Norwegian University of Science and Technology Scott Greer, Assistant Professor, University of Michigan, USA; Visiting Fellow, LSE Health 7