Intended for healthcare professionals


Devolution in Latin America has had poor effects on health care

BMJ 1999; 319 doi: (Published 03 July 1999) Cite this as: BMJ 1999;319:55
  1. Peter Sandiford, Consultant
  1. Institute for Health Sector Development, London EC1V 9HL

    EDITOR—The Editor's choice of 1 May expressed “excitement” at the possible effects of devolution on health care in the United Kingdom.1 Had the experiences of some Latin American countries been examined in addition to those of Canada, Spain, and Finland, apprehension might have been a more appropriate sentiment.

    Within Latin America, Chile, Brazil, Mexico, and Bolivia have all experimented with devolution of publicly funded health services to subnational government bodies. In these countries, as in the United Kingdom, the motives for …

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