Does the healthcare decentralization provide better public health security capacity and health services satisfaction? An analysis of OECD countries

Durmuş V.

Journal of Health Organization and Management, vol.38, no.2, pp.209-226, 2024 (SSCI) identifier identifier

  • Publication Type: Article / Article
  • Volume: 38 Issue: 2
  • Publication Date: 2024
  • Doi Number: 10.1108/jhom-01-2023-0021
  • Journal Name: Journal of Health Organization and Management
  • Journal Indexes: Social Sciences Citation Index (SSCI), Scopus, ASSIA, ABI/INFORM, CINAHL, MEDLINE
  • Page Numbers: pp.209-226
  • Keywords: Decentralization, Health policy, Health service satisfaction, OECD countries, Public health security
  • Kütahya Health Sciences University Affiliated: No


Purpose: Decentralization has profound implications for many health systems. This study investigates the effect of health system decentralization in Organization for Economic Co-operation and Development (OECD) countries on public health security capacity and health service satisfaction. Design/methodology/approach: Multiple linear regression analyses were employed for variables related to the level of health security capacity and satisfaction with the healthcare system while controlling for all socio-demographic variables from the European Social Survey, including over 44,000 respondents from 25 OECD countries. The Health Systems in Transition series of countries were used for assessing the decentralization level. Findings: The result of multiple linear regression analyses showed that the level of decentralization in health systems was significantly associated with higher health security capacity (ß-coefficient 3.722, 95% confidence interval (CI) [3.536 3.908]; p=<0.001) and health service satisfaction (ß-coefficient 1.463, 95% CI [1.389 1.536]; p=<0.001) in the study. Countries with a higher level of decentralization in health policy tasks and areas were significantly likely to have higher health services satisfaction, whereas this satisfaction had a significant negative relation with the lower level of decentralization status of secondary/tertiary care services in OECD countries (ß-coefficient −5.250, 95% CI [−5.757–4.743]; p = 0.001). Originality/value: This study contributes to a better understanding of the extent to which decentralization of health services affects public health safety capacity and satisfaction with health services, whereas the level of decentralization in OECD countries varies considerably. Overall, the findings highlight the importance of public health security and satisfaction with health care delivery in assessing the effects of decentralization in health services.