Decentralization and regionalization of health policy: a historical-comparative approach between Brazil and Spain

This article discusses the processes of decentralization and regionalization of health policy in Brazil and Spain between 1980 and 2015. The study was developed with contributions of the historical institutionalism and of the historical-comparative method, by means of three dimensions of analysis: State context; trajectory and institutionality of the decentralization and regionalization of health; and constraints. The study showed that, in both countries, the more general context of re-democratization and decentralization of the State conditioned the reforms of health systems and their political-administrative organization. In addition, historical, institutional and political factors have had a specific impact in each case, influencing the regional organization of services, the balance of power and the division of responsibilities between the governmental spheres in the management, financing and coordination of health policy. The study suggests that the way these factors interrelated over time is important for understanding the decentralization and regionalization of health systems in different contexts.