The discussion about decentralization or centralization tendencies has already been going on for several decades all over the world. Different notions concerning this question have determined the political courses of reforms in the health care sector. Given the importance of solving these questions, researchers worldwide have analysed the phenomenon of decentralizing or centralizing the health care sector, offering a wide range of scientific literature. Yet, evidence is ambiguous and no general consensus can be found regarding different aspects, including advantages and disadvantages, of either type of the organizational structure. A crucial factor, which partly explains these difficulties, is the large number of different definitions and typologies, …show more content…
Although the theoretical frameworks have flourished greatly, common components and associations can be pointed out regarding fiscal, political and administrative determinants. Taking these factors into account, Schneider (2003) has developed a new approach to analyse these concepts and to compare different countries. Based on Schneider’s theory, decentralization is explained by the following three core dimensions: fiscal, political and administrative. By describing these dimensions, advantages and disadvantages of each concept will be discussed to illustrate the complex …show more content…
A core argument supporting political decentralization is related to the concept of public participation, which again includes local responsiveness and allocative efficiency. A politically decentralized system is thus considered to ensure a higher degree of democracy and representation, translating the multiplicity of public interests into policy-decisions. However, studies discovered that weak formal structures may limit the effect of public participation reflecting on local representative decision-making (Abelson et al., 1995). Another main element concerns the possible range of incentives among different governmental levels. Cremer et al. (1996) suggests the appropriate degree of decentralization to be determined by incentives, more explicitly by which level of government expresses the most incentive to reach a certain outcome. Still, it is questioned whether the local governments’ priorities always match the incentives of the central level. While decentralization might promote some equity aspects, it might simultaneously threaten the principle of equality among local regions due to the differences in level of education, health services provided or tax rates. Moreover, the argument of democracy and representation is questioned as low turnouts at local elections and dissatisfaction with local governments reduce the
Municipal control or an alternative delivery method? This is the question that has intrigued all levels of local government and created intense debates between taxpayers across municipalities. The services that municipalities provide are often vital to the existence of a local area. The issues of accountability, cost savings, quality of service and democracy often arise when choosing the best options to deliver services to a municipal area. In recent years the concepts of privatization, alternative service delivery and public-private partnerships are often promoted as ways cut down on overburdened annual city budgets and promote a higher quality of service to citizens. Municipalities have historically always provided basic services such as fire protection, water purification/treatment and recreational facilities. However, would private companies or another municipality be able to better deliver the same services more efficiently or at a lower cost? The city or town often provides a political grass roots approach to most local problems. Municipalities are better positioned and have a wider scope to provide services to their constituents in order to ensure quality of service that does not erode accountability and transparency, or drive the municipality deeper into debt.
James Bryce, writes a quite cynical view of federalism in his paper. Though pointing out Federalism is useful in providing for expanding states and protecting against oligarchy while still fostering the creativity and flexibility of local governments with in which people can practice their civic responsibilities. With each positive point, Bryce follows it with a negative point, and even compares the some
At the beginning of the 20th century, government budgeting was a decentralized process more conducive to the small government ideals at that time. The executive branch was less involved in the process and less influential in terms of funding decisions. There were no definitive procedures and no real central authority. The submission process was informal and chaotic. Each agency subm...
Some of the advantages of having a federal government are that the national level of government can work on the bigger picture tasks while the state government solve the local and specific issues, so that each departments time can be used wisely and efficiently. Furthermore, if citizens took their everyday problems to the national level, then the national government would be over worked and the citizen might have to travel far to even reach the states capital. Each side of the
Davidson, Stephen M. Still Broken: Understanding the U.S. Health Care System. Stanford, CA: Stanford Business, 2010. Print.
To define the terminology of federalism to a simplistic way is the sharing of sovereignty between the national government and the local government. It is often described as the dual sovereignty of governments between the national and the local to exert power in the political system. In the US it is often been justified as one of the first to introduce federalism by the ‘founding fathers’ which were developed in order to escape from the overpowered central government. However, federalism in the United States is hitherto uncertain where the power lies in the contemporary political system. In this essay I will outline and explain how power relationship alternates between states and federal government. Moreover I will also discuss my perspective by weighing the evidence based upon resources. Based on these resources, it will aid me to evaluate the recent development in the federal-state relationship.
The regionalized model organizes levels of care into primary care, secondary care, and tertiary care (Bodenheimer & Grumbach, 2012). Primary care would be general practitioners, who make up the majority of physicians in Great Britain, secondary care would be physicians specializing in areas like internal medicine, pediatrics, obstetrics and gynecology and general surgeries (Bodenheimer & Grumbach, 2012). Tertiary care specialists include cardiac surgeons, immunologists, and pediatric hematologists, and they work at a few highly specialized medical centers (Bodenheimer & Grumbach, 2012). Hospitals are also organized in a similar fashion, with district hospitals serving local communities, and regional tertiary care medical centers providing highly specialized care services (Bodenheimer & Grumbach, 2012). While some think that dispersed model of care provides flexibility and convenience, others find the regionalized model of care to be more organized and less expensive (Bodenheimer & Grumbach, 2012). I have to agree with the supporters of the regionalized model of care because I would rather have a few different doctors look at me and decide on the best course of action than go straight to the cardiac surgeon. Care should be planned for a patient in a way that the patient only receives services that he or she requires, and organizing our health care delivery model in a different way can help us attain cost containment and ensure that the patient does not get unnecessary
Traurig, G., (2008/2009). Turmoil in the healthcare industry: what about the patients? The Americas Restructuring and Involvency Guide. Retrieved from http://www. americasrestructuring.com/08_SF/p100-106
National, Local, and State governments work together cooperatively to solve common problems rather than making separate polices. They work more on an equal level to get things fixed. This type of federalism is hard to tell where one type of government ends and the next one begins. National and state governments are independent and interdependent with an overlap of functions and financial resources. It is difficult for one to accumulate absolute power with this type of federalism.
The state is responsible for the overall regulatory, supervisory and fiscal functions as well as for quality monitoring and planning of the distribution of medical specialties at the hospital level (Schäfer et al., 2010). The 5 regions are responsible for hospitals and for self-employed health care professionals, whereas the municipalities are responsible for disease prevention and health promotion rel...
A country’s health care system refers to all the institutions, programs, personnel, procedures, and the resources that are used to meet the health needs of its population. Health care systems vary from one country to another, depending on government policies and the health needs of the population. Besides, health care programs are flexible in the sense that they are tailored to meet health needs as they arise. Among the stakeholders in the formulation of a country’s health care system are governments, religious groups, non-governmental organizations, charity organizations, trade/labor unions, and interested individuals (Duckett, 2008). These entities formulate, implement, evaluate, and reform health services according to the needs of the sections of the population they target.
Newman, Alex. “Examining Healthcare: A Look Around the Globe at Nationalized Systems.” The New American. 15 Sep. 2008: 10. eLibrary. Web. 04 Nov. 2013.
Nivola, P. S. (2007, July). Rediscovering federalism. Issues in Governance Studies, 8, 1-18. Retrieved June 20, 2011 from http://www.brookings.edu/views/papers/nivola/20070709.pdf
The U.S. healthcare system is very complex in structure hence it can be appraised with diverse perspectives. From one viewpoint it is described as the most unparalleled health care system in the world, what with the cutting-edge medical technology, the high quality human resources, and the constantly-modernized facilities that are symbolic of the system. This is in addition to the proliferation of innovations aimed at increasing life expectancy and enhancing the quality of life as well as diagnostic and treatment options. At the other extreme are the fair criticisms of the system as being fragmented, inefficient and costly. What are the problems with the U.S. healthcare system? These are the questions this opinion paper tries to propound.
The classical school of organization theory dominated administrations from the early 1900’s well into the 1930’s, and it is still relevant today in many of the contemporary organization theories. Shafritz states that classical organization theory was the first theory of its kind, and serves as the foundation of other schools organization theory (Shafritz, Ott, & Jang, 2011, p. 32). Classical organization theory includes scientific management approach, bureaucratic approach, and administrative management approach. Several major theorists of classical organization were Adam Smith, Frederick Taylor, Max Weber, Henri Fayol, and Luther Gulick.