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The first explanation is that local governments only have real discretion for less than 30% of their health expenditure (33), a figure which is low compared to the average of local expenditure autonomy (58%) experienced in other developing countries (14).
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A feature of particular relevance to the future of e-health in Scotland is that while the health care system is funded nationally, the geographical health boards have considerable autonomy over expenditure.
Commitment to maintaining the Barnett formula, which determines how much public expenditure Scotland gets, is not full fiscal autonomy.
Many doctors consider that these tools help rein in health expenditures, but few believe that they promote professional autonomy, quality of care or satisfactory relations with patients, as seen in Table 2.
As local governments are estimated to rely on land sales for around 60% of their revenues, the greater autonomy to raise debt to finance some expenditure is a small step toward easing their reliance on the property sector.
Is the solution to the increase of health expenditures and reduced access to health care the end of autonomy for the medical profession?
This higher degree of state autonomy helps government officials serve their own interests by spending more on administrative expenditures.
Members held lengthy debates amongst themselves on the extent of their autonomy on this issue, taking into account the restrictions on DFF expenditure.
"Preferred activities are more refreshing because they provide a feeling of autonomy and control, they are enjoyable, and they don't require additional resource expenditure," Hunter said. .
Patients seek the best obtainable care, providers aim to deliver optimal care but also strive for self-regulation and autonomy, and policymakers need to balance meeting high public demand with controlling health service expenditure.
He will have to further slash government expenditures, even in socially and politically sensitive areas; raise tax revenues; provide formal and effective autonomy to the central bank; and accelerate structural reforms to make the economy more competitive.
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