OECD Journal on Budgeting

The OECD Journal on Budgeting is published three times per year. It draws on the best of the recent work of the OECD Working Party of Senior Budget Officials (SBO), as well as special contributions from finance ministries, academics and experts in the field and makes it available to a wider community in an accessible format. The journal provides insight on leading-edge institutional arrangements, systems and instruments for the allocation and management of resources in the public sector.

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Decentralisation in the health sector and responsibilities across levels of government

Impact on spending decisions and the budget

This article sheds light on the role of subnational governments in health systems across OECD countries. The views in this article show a move away from traditional measures of decentralisation, such as the share of subnational government expenditure of total expenditure, to measures capturing a range of responsibilities in the health sector. The data comes from the 2017 OECD Survey on Performance Measurement Systems in the Health Sector and Responsibilities across Levels of Government. The results show that despite health representing a large sector of subnational government expenditure, central governments still have considerable decision-making power. This power applies to key policy-making and budgeting decisions.

JEL codes: H51, H75, I18

Key words: Decentralisation, subnational, health system


Keywords: health system, subnational, Decentralisation
JEL: H51: Public Economics / National Government Expenditures and Related Policies / National Government Expenditures and Health; H75: Public Economics / State and Local Government; Intergovernmental Relations / State and Local Government: Health; Education; Welfare; Public Pensions; I18: Health, Education, and Welfare / Health / Health: Government Policy; Regulation; Public Health
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