Could you please discuss and send references that countries with successful examples and failure of dividing health authority into subnational governments (Provinces and Local level) after federalism?
There were four model around the world; Beverage, Bismarck, Out of pocket expenditure and Mix. Through this healthcare service is delivered.
None of system is total failure. None of system assured healthcare service for entire population of any country.
In my personal view based on my involvement about twenty years at public health field;
Bismarck that is insurance system is less effective. If we look at USA, Germany will explore that discontinuation of medical care exist in USA.
Next, in out of pocket expenditure and mix method the cost of care is apparently more. Here medicine and investigation cost is paid additionally, sometime from outside.
Beverages is tax system. This is apparently good after considering availability of resources and access. UK citizens didn’t pay at hospital, government payment system from tax.
To me, premium is burden in insurance system because they pay tax, they pay premium for insurance. Many research conducted in USA, i know in 2013 people’s denied USA green card, young people denied to received healthcare services and so many discontinue medication. Now think, How Insurance assure healthcare service?
Hello,
I am Impressed with your responses and thanks Rafia Rahman , for your great response and resources. Actually I'm more curious about health system devolution in federal context.
Thank you.
Give me Ur email id, i will share that.
Before going to an individual system, i think good to know regard common practices.
We can do more discussion, i will be happy if can give any fruit full input.
Dear Keshab Rijal,
You should explore the Belgian health system to ascertain whether it corresponds to your criteria regarding the transfer of competences within the framework of federalism.
You may refer to this document: Gerkens S, Merkur S. Belgium: Health system review. Health Systems in Transition, 2020; 22(5): pp.i–237.
Print ISSN 1817-6127 Vol. 22 No. 5 Web ISSN 1817-6119 Vol. 22 No. 5
Dear Keshab Rijal, How are you?
The Brazilian Health System (SUS) is a model/case of health system that you can take into account, due to the good results from the decentralization of system management and health care. This system, since its constitutionalization in 1988 of health as a right for all with the principles of universality, integrality, equity and decentralization of management among the federated entities, has allowed a great social inclusion in the country.
Dear Keshab Rijal,
The brazilian public health system (Sistema Único de Saúde - SUS) through the Pact for Health, in 2006, defined the attributions of each sphere of government in assistance, social control and system management.
Our SUS was the result of a great social mobilization in our democracy, through which attempts were made to correct the social distortions existing in the country. After 35 years of its creation, the System is still fighting for decent funding and, even underfunded, it consolidates itself with excellence in several sectors.
Australia has responsibility for health split between State (Hospitals) and Federal (General Practice) Governments. We also have a private and public sector. It is messy because of the split - reform is challenging. There is a lot of information accessible through this link https://www.aihw.gov.au/reports-data/australias-health
The fundamental principles of public health
In Italy, the central government guarantees all citizens equal conditions and universal access to the equitable provision of health care, implementing Article 32 of the Constitution, which states, "The Republic protects health as a fundamental right of the individual and the interest of the community, and guarantees free care to the indigent. No one may be obliged to a particular health treatment except by the provision of law. The law may in no case violate the limits imposed by respect for the human person."
The basic principles the national government oversees are:
1. universality: the extension of health care services to the entire population;
2. equality: access to NHS services without any distinction of individual, social, and economic condition;
3. equity: equal access to benefits and services in relation to equal health needs.
Public responsibility for the protection of the right to health
The Constitution provides for the legislative responsibilities of the state and regions for health protection.
Regions constitute the first level of territorial subdivision of the Italian state as well as a public body endowed with political and administrative autonomy sanctioned and limited mainly by the Constitution of the Italian Republic (Art. 114-133). There are 20 regions in Italy.
The state determines the Essential Levels of Care, that must be guaranteed throughout the national territory. While the regions plan and manage health care in full autonomy within the territorial scope of their competence.
Unfortunately given the diversity of socioeconomic situations in different Italian regions, the basic principles are not always ensured everywhere.
Keshab Rijal
Federalism has had a significant impact on the Ethiopian health system. Since the adoption of the federal system in 1995, Ethiopia has implemented a decentralized health system, with health service delivery responsibilities devolved to regional governments.
Successes:
- Improved access to healthcare services: Decentralization of the health system has led to the establishment of more health centers and hospitals in rural areas, resulting in improved access to healthcare services for underserved populations.
- More equitable distribution of resources: Federalism has helped to distribute healthcare resources more equitably across the country, with greater investment in previously neglected regions.
- Increased community participation: The devolution of healthcare responsibilities to regional governments has also led to increased community participation in decision-making processes and in the provision of healthcare services.
- Improved health outcomes: There have been improvements in health outcomes in Ethiopia over the past two decades, including reductions in infant and maternal mortality rates, which can be partly attributed to the implementation of a decentralized health system.
Failures:
- Uneven distribution of resources: While federalism has led to more equitable distribution of healthcare resources overall, there are still disparities in resource allocation and access to healthcare services between different regions.
- Capacity and expertise gaps: Some regional governments have limited capacity and expertise to manage healthcare services effectively, which can lead to uneven quality of care and health outcomes.
- Lack of coordination: Coordination and communication between federal and regional authorities can be challenging, leading to duplication of efforts and inefficient use of resources.
- Weak governance and corruption: Weak governance and corruption in some regions have resulted in mismanagement of healthcare resources and services.
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