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Structure of the presentation
Highlights from the results
Background of the study
Materials and methods
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Political decentralization - the concept
Decentralization as a function of management is widely in use
The concept can be diveded at least four levels1. administrative
2. fiscal
3. political
4. market All levels have sublevels and are usually linked each other
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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?
?
?
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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?
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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
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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?
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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
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Materials and methods - future perspective
2 phase Delphi-study: 1st round in the autumn 2005 (N=98, response rate 71%) 2nd 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
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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: [email protected]
Thank you for your attention!
