Decentralization of Health Systems in Latin America: A Comparative Analysis of Chile, Colombia, and Bolivia

This comparative study evaluates the implementation of decentralization of health systems in three Latin American countries: Chile, Bolivia, and Colombia. In terms of the relationship between decentralization and system performance in general, the findings support the conclusion that both the die-hard detractors and the fervent advocates for decentralization are wrong. Decentralization appears to be improving some indicators of equity, such as a tendency toward similar per capita expenditures for wealthier and poorer municipalities, and to be associated with increased and more equitable per capita spending on promotion and prevention. However, except for the increase in utilization that comes with higher expenditures, the improved equity of expenditures does not seem to be clearly related to major changes in our indicators of performance. [From author]