14th Annual Meeting of the OECD Network on Fiscal Relations Across Levels of Government, 19-20 November 2018

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Søren H. Thomsen, Head of Department, DENMARK 2018
Decentralisation vs centralisation

2. Introduction
Agenda – two main themes
• General reflections
• The present discussions in Denmark

3. General reflections
In relation to the papers presented in this session
• ”Decentralised models have an advantage in relation to controlling the costs and obtaining
good quality.
• However, be aware of excessive decentralisation.”
• Don’t see these correlation as reflecting some kind of law of nature.
• The correlation reflects decisions taken by politicians and administrators.
• The next question is: Why do the actual decisions end up with what seems to the advantage
of decentralised models.
• By the end of the day – decisions of decentralisation or not is a political decision.

4. Denmark – a new health care reeform ?
The present debate in Denmark
• The hospital sector is changing –more services are delivered outside the hospitals.
• The role of local governments and general practitioners (GP) will increase
• More services should be delivered locally.
• Better cooperation between hospitals, local governments af GPs.
• Equality in services.
• Where are we going ?
• Is the answer a more decentralised or a more centralised health care system?