Abstract
Decentralization is one of the tools for the development of a health system which can produce many
benefits, such as improvements in technical and allocative efficiency, and improvements in the responsiveness
of the health system in meeting the needs of the people. According to Rondinelli(1), decentralization has been categorized into deconcentration, devolution, delegation and privatization. In Thailand, an
increasing emphasis has been put on community participation and decentralization following the Constitution
of B.E. 2540 and the Decentralisation Act of B.E. 2542 which has led to the development of the
Decentralization Plan of B.E. 2544 and the Devolution Plan to Local Administrative Organizations in B.E.
2545. These plans dictated that the provision of public services was to be devolved to LAO, and this
includes the transfer of infrastructure and the authority to provide health and health promotion services.
This study examines these issues by reviewing the international experience of Portugal, Spain, Italy, Mexico,
and the United Kingdom in health system decentralization.
From the review, after the reform, decentralization has led to many benefits in the provision of
health services and in the health system as a whole. In Portugal, it was found that the health status of the
population improved significantly after improvements were effected in access to care. Furthermore, the
local authority has become more autonomous and more flexible in being more responsive and efficient.
Also, in Italy and the United Kingdom, the internal market and the purchaser-provider split have been
introduced in order to improve efficiency, quality and service satisfaction. However, problems related to
decentralization were also found. For example, the occurrence of political conflicts from the reform, inequity
which emerged in many forms, problems relating to responsiveness in the deconcentration system,
and problems with unfavorable conditions and contracts in the internal market system.
