Abstract

The article analyses the health care reforms carried out by several European countries during last 20 years; it specifically focuses on the process of decentralization concerning political, financial and organizational competences. In the first section, the concept of health care decentralization is discussed; then the different health care systems of Norway, Sweden, UK and Spain will be compared, confronting their recent reforms and the balance between decentralization and re-centralization in their health care systems. In particular, the article addresses two main questions: the first one concerns the impact of such national reforms on intergovernmental relations, especially those between the State and the regions; the second questions relates instead to the impact of reforms on the organization and delivery of health care services. What comes out, in conclusion, is that differences in efficiency, quality and equity could depend on specific governance mixes of decentralization and re-centralization.