As one of the most contested social policy responsibilities of governments in the 21st century, healthcare is a topic of global importance. In most high-income countries and increasingly in middle income countries, health care constitutes the single largest category of government expenditure. Federalism and health system decentralization involves complex administrative and political structures, including issues concerning jurisdictional overlap and uneven fiscal capacities. The Forum’s previous comparative work and continued programming on this topic recognizes both the structure and actual practice in terms of “decision space” or decision-making authority as crucial factors that largely determine the degree and character of decentralized health systems across different federations.
