Book Launch: Federalism and Decentralization in Health Care: A Decision Space Approach

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Thursday, October 25th, 2018

Thursday, October 25, 20182:00PM - 4:00PMCanadiana Building, Room 160
14 Queen's Park Cres W, Toronto
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Even though health system decentralization is often associated with federations, there has been limited study on the connection between federalism and the organization of publicly financed or mandated health services. Federalism and Decentralization in Health Care examines eight federations that differ in terms of their geography, history and constitutional and political development. Looking at Canada, Brazil, Germany, Mexico, Nigeria, Pakistan, South Africa and Switzerland, it explores vital health care issues such as constitutional responsibility, national laws, and the source and organization of public revenues.

Beyond these structural features, each country case system is subjected to a “decision space analysis” to determine the actual degree of decentralization. A core question is whether national and subnational governments have narrow, moderate or broad discretion in their decisions on governance, access, human resources, health system organization and financing. This comparative approach highlights the similarities and differences among these federations.


Piali Roy


Gregory P. Marchildon
Ontario Research Chair in Health Policy and System Design, Institute of Health Policy, Management and Evaluation and Professor of Public Policy, University of Toronto

Thomas J. Bossert
Director of International Health Systems Program, T.H. Chan School of Public Health, Harvard University

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