Centralization and innovation: Competing priorities for health systems?. (12th June 2022)

• Record Type: Journal Article
• Authors: Scarffe, Andrew D.; Coates, Alison; Evans, Jenna M.; Grudniewicz, Agnes
• Is Part Of: International journal of health planning and management. Volume 37:Number 5(2022)
• Page Start: 2534
• Page End: 2541
• Publication Date: 2022-06-12
• Subjects: centralisation -- health systems -- innovation -- management -- organizational structure; Health planning -- Periodicals; Health services administration -- Periodicals; Santé publique -- Planification -- Périodiques; Santé, Services de -- Administration -- Périodiques; 362.1068
• DOI: 10.1002/hpm.3531
• Languages: English
• ISSNs: 0749-6753

Abstract

Abstract: Over the last 15 years, there has been a trend in Canada to centralise the provision of health services that were previously administratively and fiscally decentralised. Canadian policy rhetoric on centralisation often identifies improved innovation as an anticipated outcome. This paper challenges the assumed relationship between centralisation and innovation. We incorporate evidence from the management literature into the debate on the structure of health systems to explore the effects that centralisation is likely to have on innovation in health systems. The findings of this paper will be of interest to international policymakers, who are currently grappling with the prospect of maintaining a decentralised approach or adopting a more centralised health system structure in the future. Highlights: Health system policy rhetoric often assumes centralisation promotes innovation. Management research suggests centralisation negatively influences innovation. Innovation requires front‐line and middle manager input in decision‐making. Policy goals should be informed by interdisciplinary evidence.