1. 1 Political decentralization in health care Minna Kaarakainen Researcher minna.kaarakainen@uku.fi

2. 2 Structure of the presentation Highlights from the results Background of the study Materials and methods

3. 3 Political decentralization - the concept  Decentralization as a function of management is widely in use  The concept can be diveded at least four levels 1.administrative 2.fiscal 3.political 4.market  All levels have sublevels and are usually linked each other

4. 4 Political decentralization Citizen votes in election and decentralizes hers/his political power to elected official Elected officials are using the given political power for society What if the system will change and this political power will be re-decentralized from original elected officials to new officials? What this means to citizens rights? ? ?

5. 5 Political decentralization - the levels  Means transform the the political power from central governtment to local government  Usually needs legislative reform and creating local political units  Can happen also inside the health care organization - municipal administrator delegate it's decision-making power of political decision making  Questions of citizen rights: once citizen has elected an official, can administrator pass it over to some one else?

6. 6 Finnish health care system  has undergone an interesting development process moving from a centralized national welfare state to autonomous municipal services  municipal primary care remains the foundation of the system- municipalities are obligated to organise primary health care for its citizens - extreme decentralized system

7. 7 Finnish health care system  Municipalities can organise these services:  by themselves,  with other municipalities or  buying the services from the private sector  Municipalities have serious problems in organizing the services - The Project "Paras" was launched in 2005 - aim is to restructure local government and services → small size municipalities has to assimilate to the other municipalities → political power will be centralized to larger units - what will happen to citizens rights?

8. 8 Materials and methods - historical perspective  Content analysis of the political and legislative papers from 1945 to date  64 documents: 1.government platforms 2.legistlation of health care 3.legistlation of municipalties 4. political papers

9. 9 Materials and methods - future perspective  2 phase Delphi-study:  1 st round in the autumn 2005 (N=98, response rate 71%)  2 nd round in the autumn 2006 (N=89, response rate 80%)  the panel consisted of:  elected officials of the municipalities  primary care decision-makers  39 municipalities all over Finland

10. 10 For further inquiries, please contact: Minna Kaarakainen Department of Health Policy and Management University of Kuopio P.O.Box 1627 FI-70211 Kuopio FINLAND Tel. + 358 17 162 329 email: minna.kaarakainen@uku.fi Thank you for your attention!