Decentralized governance a way forward for hospitals – but context is key

Hospitals in Europe face many challenges, including increasing cost pressures, technological changes and the shifting burden of disease, not to mention growing patient expectations. A new policy brief has been released by the European Observatory on Health Systems and Policies, exploring the experience of 10 European countries using decentralized governance models to help hospitals adapt to increasing pressures and better meet the needs of patients.

The movement to increase autonomy in hospitals comes as a result of increased political pressure to restructure traditional governance mechanisms, enabling hospitals to not only increase efficiency through local purchasing preferences, but also to be more flexible in meeting the needs of the local population and offering more people-centred services.

The policy brief, which includes case studies from Denmark, England, Finland, France, Germany, Italy, Netherlands, Scotland, Spain and Sweden, includes several different approaches to decentralized hospital governance. It also presents examples of how some commonly encountered barriers, such as inequity between areas of authority, and the loss of the economic benefits that scale can bring to centralized models, can be overcome through the collaboration of subnational bodies in coordinating their investment and planning.

While these examples of success are encouraging, the policy brief does also emphasize the importance of context. Differing institutional arrangements in countries, along with the values underpinning them, inevitably shape what can be achieved from decentralization policies. So while it may not be possible to transfer the experience or model of one country to another, important lessons can still be learned by policy-makers, provided their reforms are tailored to their country-specific challenges and existing institutional systems.