Effects of decentralization and recentralization on economic dimensions of health systems.

Decentralization has become a popular management strategy in many European health care systems. The term describes a wide variety of power transfer arrangements and accountability systems. The logic of decentralization is grounded in an intrinsically powerful idea; that smaller organizations, properly structured and steered, are inherently more agile and accountable than larger organizations. In a world where large organizations control wide swathes of both public and private sector activity, the possibility of establishing more locally operated, locally responsible institutions holds out great attraction. This text explores the capacity and impact of decentralization within European health care systems. It examines both the theoretical underpinnings as well as recent practical experiences, drawing upon both published literature and evidence collected directly from the field.