Descentralización de los sistemas sanitarios europeos: ¿entre la innovación y la eficiencia?

Health care is one of the main public policy areas in which management has been decentralised at sub-state level in Europe. However, given the complexities of health care funding, economic research into the effects of such decentralisation, and particularly into vertical and horizontal imbalances, comes up against considerable limitations. This article seeks to offer an interpretation of the large body of literature on this area The studies reviewed show improvements in innovation in specific health care system programmes and improvements in equity and long-term inefficiency, albeit to a lesser extent. However most decentralised health-care systems continue to suffer from design problems, particularly vertical imbalances, which give rise to so-called «healthcare deficits», when sub-central budget constraints are perceived as weak. On the other hand, experiences of decentralisation seem to indicate that there is a reducing effect that decreases horizontal fiscal imbalances.