Gesundheitswesen 2014; 76 - A147
DOI: 10.1055/s-0034-1386997

Which Road to go for Europe regarding Health: Federation, Union or becoming Swiss?

K Rieger 1, H Brand 1
  • 1Universität Maastricht, die Niederlande, Maastricht

Background: The newly elected European Parliament and European Commission will face a long and ongoing discussion which governing model suits Europe best. Federation or Union is one option but the highly decentralized system of Switzerland is winning more popularity as an alternative. Regarding health the sub national or region level is important because the regions mostly provide health. However, little is known on the impact of state organization (the combination of the degree of federalism and the degree of decentralization). This paper for the first time investigates the influence of state organization on health system performance in Europe.

Methods: Three different data sources were used to describe health system performance: The WHO World Health Report 2000, the Health Policy Scores by Mackenbach & McKee and the European Community Health Indicators (ECHI). State organization was analyzed with both the Regional Authority Index (RAI) and the Federalism and Decentralization Indicators (FDI) by Biela. RAI focuses on the decentralization of institutional competencies based on national documents. FDI pictures fiscal competencies based on World Bank data. Relationships between state organization (RAI, FDI) and health system performance were established by regression analysis.

Results: FDI is not significantly correlated with any of the three health system performance data sets. However, FDI points to unitary centralized organization (WHO Health Report) or to more decentralization (Health Policy Scores, ECHI). A positive significant correlation exists between RAI and both the WHO Health Report and the ECHI datasets at the 0.05 level. RAI is positive but not significantly related to the Health Policy Scores.

Conclusions: For the first time a relationship between state organization and health system performance was established. The results indicate that health system performance seems to be independent from overall state organization. However, as RAI indicates, decentralization when applied cautiously can be a beneficial tool.

Key Message:

  • Health system performance seems to be independent from overall state organization,

  • Decentralization can be beneficial to a certain degree.