Health care based on priorities is lost in decentralisation

doi:10.1136/bmj.331.7510.235

BMJ 2005;331:235 (23 July), doi:10.1136/bmj.331.7510.235

Letter

Health care based on priorities is lost in decentralisation

The first 150 words of the full text of this article appear below.

EDITOR—Decentralisation of the health system was appliedin all transition countries in the 1990s.^1-3 In most countriesit was encouraged by the necessity to reform the inherited modelof health organisation and to achieve the final goal—anefficient and fair health system. Croatia has special experiencein decentralisation, primarily because of its geographical,political, and administrative circumstances but also becauseof its decentralised health system during the socialist regimein the 1980s.

Firstly, Croatia is a country with extreme differences betweenits regions. The income per head in the richest region is 10times that in the poorest region.

Secondly, decentralisation reforms were not based on analysesof the problems and assessment of resources but on maintainingthe framework within which they were implemented. Such implementationof the changes resulted in a complete change of the essenceof the local health system, whereas the given framework imposedlimitations . . . [Full text of this article]

Aleksandar Dzakula, research fellow

Andrija Stampar School of Public Health, Rockefellerova 4, Zagreb, Croatia adzakula@snz.hr