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Political decentralization in health care

Political decentralization in health care. Minna Kaarakainen Researcher minna.kaarakainen@uku.fi. Structure of the presentation. Highlights from the results Background of the study Materials and methods. Political decentralization - the concept.

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Political decentralization in health care

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  1. Political decentralization in health care Minna Kaarakainen Researcher minna.kaarakainen@uku.fi

  2. Structure of the presentation • Highlights from the results • Background of the study • Materials and methods

  3. Political decentralization - the concept • Decentralization as a function of management is widely in use • The concept can be diveded at least four levels • administrative • fiscal • political • market • All levels have sublevels and are usually linked each other

  4. What if the system will change and this political power will be re-decentralized from original elected officials to new officials? What this means to citizens rights? ? Elected officials are using the given political power for society ? Citizen votes in election and decentralizes hers/his political power to elected official Political decentralization

  5. Political decentralization - the levels • Means transform the the political power from central governtment to local government • Usually needs legislative reform and creating local political units • Can happen also inside the health care organization - municipal administrator delegate it's decision-making power of political decision making • Questions of citizen rights: once citizen has elected an official, can administrator pass it over to some one else?

  6. Finnish health care system • has undergone an interesting development process moving from a centralized national welfare state to autonomous municipal services • municipal primary care remains the foundation of the system- municipalities are obligated to organise primary health care for its citizens - extreme decentralized system

  7. Finnish health care system • Municipalities can organise these services: • by themselves, • with other municipalities or • buying the services from the private sector • Municipalities have serious problems in organizing the services - The Project "Paras" was launched in 2005 - aim is to restructure local government and services→small size municipalities has to assimilate to the other municipalities → political power will be centralized to larger units - what will happen to citizens rights?

  8. Materials and methods - historical perspective • Content analysis of the political and legislative papers from 1945 to date • 64 documents: • government platforms • legistlation of health care • legistlation of municipalties • political papers

  9. Materials and methods - future perspective • 2 phase Delphi-study: • 1st round in the autumn 2005 (N=98, response rate 71%) • 2nd round in the autumn 2006 (N=89, response rate 80%) • the panel consisted of: • elected officials of the municipalities • primary care decision-makers • 39 municipalities all over Finland

  10. Thank you for your attention! • For further inquiries, please contact: • Minna Kaarakainen • Department of Health Policy and Management • University of Kuopio • P.O.Box 1627 • FI-70211 Kuopio • FINLAND • Tel. + 358 17 162 329 • email: minna.kaarakainen@uku.fi

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