La governance della politica sanitaria in Europa tra decentramento e ri-accentramento: alcuni casi a confronto

The article analyses the health care reforms carried out by several European countries during last 20 years; it specifically focuses on the process of decentralization concerning political, financial and organ- izational competences. In the first section, the concept of health care decentralization is discussed; then the different health care systems of Norway, Sweden, UK and Spain will be compared, confronting their recent reforms and the balance between decentralization and re-centralization in their health care systems. In particular, the article addresses two main questions: the first one concerns the impact of such national reforms on intergovernmental relations, especially those between the State and the regions; the second questions relates instead to the impact of reforms on the organization and delivery of health care services. What comes out, in conclusion, is that differ- ences in efficiency, quality and equity could depend on specific gov- ernance mixes of decentralization and re-centralization.