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Policy interdependence and the models of health care devolution: “systems or federacies”?

Costa-I-Font, Joan and Perdikis, Laurie (2019) Policy interdependence and the models of health care devolution: “systems or federacies”? Regional Science Policy & Practice. ISSN 1757-7802 (In Press)

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A number of European countries have devolved health care services to subnational units. This is especially the case in unitary states that are organised as a national health services (NHS), where choice is not ‘build in’ the health system and funding is based on general taxation. This policy review paper argues that, in such settings, there are two distinct models of devolving authority to subnational jurisdictions: a ‘federacy model’ where only a few territories obtain health care responsibilities (such as in the United Kingdom), and a ‘systems model’ where the whole health system is devolved to a full set of subnational units, (such as in Spain). The choice of one or the other influences the spatial diversity of health care activity and the extent of policy interdependence across regions. We discuss evidence from the UK and Spain to shed some light on the likely effect of each model of devolution. Our results indicate that a ‘system model’ gives rise to significant policy interdependence and lower regional than a ‘federacy model’.

Item Type: Article
Official URL:
Additional Information: © 2019 John Wiley & Sons, Inc
Divisions: Health Policy
Subjects: R Medicine > RA Public aspects of medicine
H Social Sciences > HC Economic History and Conditions
Date Deposited: 25 Oct 2019 08:27
Last Modified: 19 Jan 2020 00:27

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