GOLD Report I - UCLG

EUROPE138United Cities and Local Governments10. The management ofthe health system isnot part of the localgovernments’functions.Today these kinds of tasks are carried outby second-tier local authorities in Centraland Eastern Europe, particularly in Croatia(Z v upanije), Hungary (megyiei), Poland(powiat) and Romania (judet). They arealso part of the responsibilities delegatedto the Czech and Slovak “regions” (kraj).Three factors differentiate these secondtierlocal authorities: size, urban administrationsystem, and the presence orabsence of competing sector-specificauthorities.In countries that were significantly affectedby the late arrival of local self-governmentin rural areas, or were heavilyinfluenced by Germany or Austria, second-tierlocal authorities are apt to besmall (German Kreis and Polish powiat inparticular). Other countries have largerauthorities, including France with itsdépartement, England and Sweden withcounties, and Hungary with its megyei.This applies as well to provinces in Belgium,Italy, the Netherlands and Spain,nomos in Greece, and Czech and Slovak“regions.” Except for the Czech Republicand Slovak Republic, these territorial divisionshave ancient origins and are connectedto the administrative divisions ofthe state authorities that preceded thecreation of local authorities. But differencesin size do not necessarily correspondto differences in responsibilities. The responsibilitiesdelegated to this tier ofgovernance depend more on the extentand nature of powers and responsibilitiesexercised at the municipal level, the roleof state authorities, and the presence ofsector-specific authorities.Cities in several countries are not includedin the territorial framework of second-tierauthorities, though they mayhave similar responsibilities. This correspondsto an institutional differentiationbetween city and countryside with respectto the local authority system, the significanceof which has been emphasised. Incountries where cities assume much second-tierresponsibility, they benefit froma reinforced status within the administrativesystem. This was the situation in theUnited Kingdom between 1888 and 1972(the borough-counties), and again afterthe removal in 1986 of county councils inmetropolitan areas. A decade later theUnited Kingdom saw the constitution ofunitary councils. A similar ascendancy ofthe city occurs in Hungary where 22towns have the status of megyei, in Germanywith 116 kreisfreie Städte, and inPoland which accords to 65 towns the statusof powiat. A similar system existed inDenmark before that country’s 1970 territorialreforms.The presence of specialized sector-specificauthorities, such as hospitals, affectsthe powers and responsibilities at theintermediate level. Public hospitals are incorporatedat the intermediate level localgovernment in Denmark, Sweden andHungary, whereas they are part of anational organization in the United Kingdom(the National Health Service), inFrance with the regional hospital careagencies (though hospitals have kepttheir legal status as local public corporations)and in Italy though the regionsfinance “local health units.” Similar arrangementsalso characterize the educationsector in many countries.In federal states and states with regionalautonomies, it is the federated states orautonomous regions which have taken onresponsibility for these services, directlyor indirectly. In Germany, the Länder areresponsible for education and for the statutoryregulation of hospitals, and also forinvestment in public hospitals. However,management in these areas is devolved tothe districts. In Spain, public hospitalswere transferred to the autonomous communitiesin 2002. In the United Kingdom,the national health system is under thesupervisory control of regional authoritiesin Scotland and Wales, but is nonethelessorganized according to sector-based principles10 . In Belgium, health and education