ArticleInternational journal of health policy and management2023
Challenges in Assessment of Health Systems Decentralization: The Role of Path Dependence and Choice of Indicators Comment on "The Effects of Health Sector Fiscal Decentralisation on Availability, Accessibility, and Utilisation of Healthcare Services: A Panel Data Analysis".
Article in International journal of health policy and management, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Uptake and Inequalities in Exercise-Based Cardiac Rehabilitation After Decentralization.JAMA network open · 2026Article
- Unveiling and understanding health inequalities: A bi-clustering study on SDG3 implementation in the Italian regions.PloS one · 2026Article
- Support Vector Machine-Based Prediction Model for Healthcare Workforce Transition Success Under Decentralization.F1000Research · 2025Article
- The Dangers of Fiscal Decentralisation in Healthcare: A Response to the Recent Commentaries.International journal of health policy and management · 2023Article
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1 author.
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No grant is acknowledged in the PubMed record.
Abstract
Optimal resource allocation within national health systems represents the ultimate challenge in diverse countries worldwide. Major part of the literature points that health systems decentralization potentially address the challenge. The present commentary focuses on the debate referring to effects of health systems decentralization, based on the evidence of the study of Arianna Rotulo and colleagues. Studies on the subject emphasize the role of path dependence and the influence of choice of indicators for measurement of effects in the assessment of health systems decentralization. Acknowledging the complexity of the phenomena, the results of the study of Rotulo et al on health system decentralization in Italy are highlighted through the analysis of recent evidence from the literature. The present commentary shows that there are diverse indicators adopted in the literature on the subject, pointing to mixed results, depending on country characteristics and selection of indicators in the analysis. The synthesis of indicators gathered in recent studies also indicate that health system indicators are sensitive to path dependence, thus, requiring additional attention to assumptions of studies on health systems decentralization. Thus, studies should consider the influence of path dependence on organizational practices and institutional structures involved in decentralization processes, in addition to acknowledging that assessments on decentralization vary substantially according to indicators adopted in the analysis, and their links with previous decisions within health systems.
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Registered trials
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