Federalismo y asistencia sanitaria: distribución de competencias y fianciación en Estados Unidos, Canadá y Alemania

The aim of this paper is to analyze the decisión-making and financial repercussions that the introduction of healthcare has had in the federal states. For this, a historical analysis is made of three states with a long federal tradition, but of a different health system: USA, Canada and Germany. It...

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Gorde:
Xehetasun bibliografikoak
Egile nagusia: Sáenz Royo, Eva
Formatua: Artikulua
Hizkuntza:Gaztelania
Argitaratua: 2020
Gaiak:
Sarrera elektronikoa:https://dialnet.unirioja.es/servlet/oaiart?codigo=7652104
Baliabidea:Revista de estudios políticos, ISSN 0048-7694, Nº 190, 2020, pags. 71-96
Etiketak: Etiketa erantsi
Etiketarik gabe: Izan zaitez lehena erregistro honi etiketa jartzen
Laburpena: The aim of this paper is to analyze the decisión-making and financial repercussions that the introduction of healthcare has had in the federal states. For this, a historical analysis is made of three states with a long federal tradition, but of a different health system: USA, Canada and Germany. It will not be discussed here which of them is more efficient for the health coverage of citizens, but their competencies (what level of government assumes decisions) and financial (what level of government pays them), as well as the congruence between the two. From this analysis it can be seen that the incorporation of health care in federal structures meant not only a centralization of competencies, but also a restructuring of funding sources and spending. On the other hand, it is also observed that the financial capacity of the center and of the territories is what will determine its decision-making capacity, above, even, of the formal system of competence distribution. In fact, conflicts between the center and the territories in the comparative experience are born, not when it is decided outside the competence system, but when it is decided, but without granting sufficient resources. Hence, the configuration of the financing system of the territorial units of a federal State is fundamental for the distribution of competences in healthcare in practice.