Decentralisation in the health care sector has been perceived in these last years as a means to revamp the performance of health care systems. Many European countries have undergone this process of delegating funding and/or management responsibilities to sub-layers of government. However, there has also been a recentralisation of health care systems in Nordic states, which typically had a highly decentralised model of service provision and funding. Three country cases will be analysed (Italy, Spain and Norway) and light will be shed on some possible difficulties that Italy and Spain might experience, given their present health decentralised structure. Moreover, there will be an analysis of the reasons that led to recentralisation of health care in Norway. The scope is to make people aware that decentralisation per se is not always successful. The three country cases highlight possible drawbacks that can arise from decentralisation. © 2005 Elsevier Ireland Ltd. All rights reserved.
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