Tags

Type your tag names separated by a space and hit enter

Decentralization and central and regional coordination of health services: the case of Switzerland.
Int J Health Plann Manage. 2000 Apr-Jun; 15(2):103-14.IJ

Abstract

As part of reforms in the health care delivery sector, decentralization is currently promoted in many countries as a means to improve performance and outcomes of national health care systems. Switzerland is an example of a country with a long-standing tradition of decentralized organization for many purposes, including health care delivery. Apart from the few aspects where the responsibility is at the federal level, it is the task of the 26 cantons to organize the provision of health services for the population of around 7 million people. This permits the system to be responsive to local priorities and interest as well as to new developments in medical and public health know-how. However, the increasing and complex difficulties of most health care delivery systems raise questions about the need for mechanisms for coordination at federal level, as well as about the equity and the effectiveness of the decentralized approach. The Swiss case shows that in a strongly decentralized system, health policy and strategy elaboration, as well as coordination mechanisms among the regional components of the system, are very hard to establish. This situation may lead to strong regional inequities in the financing of health care as well as to differences in the distribution of financial, human and material inputs into the health system. The study of the Swiss health system reveals also that, within a decentralized framework, the promotion of cost-effective interventions through a well-balanced approach towards promotional, preventive and curative services, or towards ambulatory and hospital care, is difficult to achieve, as agreements between relatively autonomous regions are difficult to obtain. Therefore, a decentralized system is not necessarily the most equitable and cost-effective way to deliver health care.

Authors+Show Affiliations

Swiss Centre for International Health, Swiss Tropical Institute, Basel, Switzerland. kaspar.wyss@unibas.chNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11009945

Citation

Wyss, K, and N Lorenz. "Decentralization and Central and Regional Coordination of Health Services: the Case of Switzerland." The International Journal of Health Planning and Management, vol. 15, no. 2, 2000, pp. 103-14.
Wyss K, Lorenz N. Decentralization and central and regional coordination of health services: the case of Switzerland. Int J Health Plann Manage. 2000;15(2):103-14.
Wyss, K., & Lorenz, N. (2000). Decentralization and central and regional coordination of health services: the case of Switzerland. The International Journal of Health Planning and Management, 15(2), 103-14.
Wyss K, Lorenz N. Decentralization and Central and Regional Coordination of Health Services: the Case of Switzerland. Int J Health Plann Manage. 2000 Apr-Jun;15(2):103-14. PubMed PMID: 11009945.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decentralization and central and regional coordination of health services: the case of Switzerland. AU - Wyss,K, AU - Lorenz,N, PY - 2000/9/30/pubmed PY - 2000/9/30/medline PY - 2000/9/30/entrez SP - 103 EP - 14 JF - The International journal of health planning and management JO - Int J Health Plann Manage VL - 15 IS - 2 N2 - As part of reforms in the health care delivery sector, decentralization is currently promoted in many countries as a means to improve performance and outcomes of national health care systems. Switzerland is an example of a country with a long-standing tradition of decentralized organization for many purposes, including health care delivery. Apart from the few aspects where the responsibility is at the federal level, it is the task of the 26 cantons to organize the provision of health services for the population of around 7 million people. This permits the system to be responsive to local priorities and interest as well as to new developments in medical and public health know-how. However, the increasing and complex difficulties of most health care delivery systems raise questions about the need for mechanisms for coordination at federal level, as well as about the equity and the effectiveness of the decentralized approach. The Swiss case shows that in a strongly decentralized system, health policy and strategy elaboration, as well as coordination mechanisms among the regional components of the system, are very hard to establish. This situation may lead to strong regional inequities in the financing of health care as well as to differences in the distribution of financial, human and material inputs into the health system. The study of the Swiss health system reveals also that, within a decentralized framework, the promotion of cost-effective interventions through a well-balanced approach towards promotional, preventive and curative services, or towards ambulatory and hospital care, is difficult to achieve, as agreements between relatively autonomous regions are difficult to obtain. Therefore, a decentralized system is not necessarily the most equitable and cost-effective way to deliver health care. SN - 0749-6753 UR - https://www.unboundmedicine.com/medline/citation/11009945/Decentralization_and_central_and_regional_coordination_of_health_services:_the_case_of_Switzerland_ L2 - https://doi.org/10.1002/1099-1751(200004/06)15:2<103::AID-HPM581>3.0.CO;2-S DB - PRIME DP - Unbound Medicine ER -