Decentralisation Processes in Montenegrin Public Administration: Challenges of Health System

  • Ivan Radević University of Montenegro, Faculty of Economics
  • Miro Haček University of Ljubljana, Faculty of Social Sciences
Keywords: local self-government, public services, health system, Montenegro, decentralisation, organizational design


The paper aims to assess the organisational design of the public health care system of Montenegro from the organisational and legal standpoint, and in particular from the position of a likelihood for the system decentralisation through an inclusion of local self-governments with the goal to increase the quality of health care. The qualitative analysis is based on the method of case study. The research covers the analysis of Montenegrin legislation, and in particular Montenegrin and European regulations and strategic documents that refer to local self-governments and health care system. Individual and group interviews were conducted with top executives in the Ministry of Health of Montenegro, Health Insurance Fund of Montenegro and Ministry of Public Administration. The research shows that Montenegrin health system is predominantly centralised, and lacks substantial involvement by local self-government in health care related services. The need for a stronger participation of municipalities (and private entities) is indicated, for the purpose of achieving a stronger level of quality of the health care services.


Addicott, R. (2008) Models of governance and the changing role of the board in the “modernised” UK health sector, Journal of health organization and management, 22(2), pp. 147-163, https://

Albers, S., Abraham B. M. & Shani, R. (2014) Healthcare: An Ecosystem in Transition" In Reconfiguring the Ecosystem for Sustainable Healthcare, Organizing for Sustainable Effectiveness, 4, pp. 1-29,

Allen, D. (2018) Analysing healthcare coordination using translational mobilization, Journal of Health Organization and Management, 32, pp. 358-373,

Athanasiadis, A., Ratsika, N., Trompoukis, C. & Philalithis, A. (2018) The health decentralization process in Greece: the insiders’ perspective, International Journal of Health Governance, 23(4), pp. 316-329,

Björnberg, A. (2017) Euro Health Consumer Index 2017 (Marseillan: Health Consumer Powerhouse).

Blažić, Đ. (2009) System of Local Self-Government (Podgorica: Faculty of Administrative and European Studies).

Blažić, Đ. (2011) System of Local Self-Government (Podgorica: Faculty of Administrative and European Studies).

Brezovnik, B. (2014) Contradictions in the concept of public institutes in Slovenian legislation, Lex Localis – Journal of Local Self-Government, 12(2), pp. 311–327.

Brezovšek, M. & Kukovič, S. (2015) Evropska javna uprava (Ljubljana: Fakulteta za družbene vede).

Burau, V. & Vrangbæk, K. (2008) Institutions and non-linear change in governance: Reforming the governance of medical performance in Europe, Journal of health organization and management, 22(4), pp. 350-367,

Coaffee, J. & Johnston, L. (2005) The management of local government modernisation: Area decentralisation and pragmatic localism, International journal of public sector management, 18(2), pp. 164-177,

Council of Europe (1985) European Charter of Local Self-Government, available at: (January 1, 2019).

Dickinson, H. & Pierre, J. (2016) Between substance and governance: Healthcare governance and the limits to reform, Journal of health organization and management, 30(1), pp. 109-116,

Dinh, T. & Bounajm, F. (2013) Improving Primary Health Care Through Collaboration: Briefing 3 – Measuring the Missed Opportunity, The Conference Board of Canada, available at: (January 1, 2019).

Drnovšek, K. & Brezovnik. B. (2016) Public Services Concession in Slovenian Legislation, Lex Localis – Joournal of Local Self-government, 14(3), pp. 671–694,

Eisenmann, C. (1988) Cours de droit administratif, Tome I, X edition (Paris).

Ford, R. & Angermeier, I. (2008) Creating a learning health care organization for participatory management: a case analysis, Journal of health organization and management, 22(3), pp. 269-293,

Garpenby, P. & Bäckman, K. (2016) Formal priority setting in health care: the Swedish experience, Journal of health organization and management, 30(6), pp. 891-907,

Gerstlberger, W. D. & Schneider, K. (2013) Outsourcing and concession models as door opener for public-private partnerships in the European health sector?, International Journal of Public Sector Management, 26(7), pp. 554-575,

Goddard, M. & Mannion, R. (2006) Decentralising the NHS: rhetoric, reality and paradox, Journal of health organization and management, 20(1), pp. 67-73, https://

Government of Montenegro (2016) Public Administration Reform in Montenegro 2016–2020, available at:, (January 1, 2019).

Government of Montenegro (2018) Proposal of the Law on Budget for Year 2019, available at: (January 1, 2019).

Greer, P., Murphy, A. & Ogard, M. (2005) Guide to participatory democracy in Bosnia and Herzegovina and Serbia and Montenegro (Strasbourg: Council of Europe publishing).

Guga, E. (2018) Local government modernization in Albania: Historical background and the territorial reform 2015-2020, International Journal of Public Sector Management, 31(4), pp. 466-506,

Heilmann, S. (2008) From local experiments to national policy: the origins of China’s distinctive policy process, The China Journal, 59, pp. 1-30.

Janssen, M. & Moors, E. H. M. (2013) Caring for healthcare entrepreneurs — Towards successful entrepreneurial strategies for sustainable innovations in Dutch healthcare, Technological Forecasting & Social Change, 80, pp. 1360–1374,

Kassak, K. M., Ali, M., Tauk, M. & Abdallah, A. M. (2007) The quest for health care decentralization: revisiting decree 159, Journal of Public Budgeting, Accounting & Financial Management, 19(4), pp. 447-461,

Katon, W., Lin, E., Von Korff, M., Ciechanowsk, I. P., Ludman, E., Young, B., Peterson, D., Rutter, C. M., McGregor, M. & McCulloch, D. (2011) Collaborative care for depression and chronic illnesses, New England Journal of Medicine, 364(13), pp. 1278-1279,

Kavčič, M., Pahor, M. & Domajnko, B. (2015) User involvement in Slovenian healthcare, Journal of health organization and management, 29(5), pp. 595-610,

Kingsnorth, R. (2013) Partnerships for health and wellbeing: Transferring public health responsibilities to Local Authorities, Journal of Integrated Care, 21(2), pp. 64-76,

Kukovič, S. (2018) Coping with demographic challenges: case of Slovenian local communities, Journal of Comparative Politics, 11(2), pp. 83-100.

McCluskey, W. J., Bevc, I. (2007) Fiscal decentralization in the Republic of Slovenia: an opportunity for the property tax, Property Management, 25(4), pp. 400-419, https://

Meirovich, G., Brender-Ilan, Y. & Meirovich, A. (2007) Quality of hospital service: the impact of formalization and decentralization, International Journal of Health Care Quality Assurance, 20(3), pp. 240-252,

Millar, R., Jian, W., Mannion, R. & Miller, R. (2016) Healthcare reform in China: making sense of a policy experiment?, Journal of health organization and management, 30(3), pp. 324-330,

Milošević, M. (2018) Public Administration Reform. How far is 2020? (Podgorica: Institut Alternativa).

Prysmakova, P. (2016) From compliance to commitment: centralization and public service motivation in different administrative regimes, International Journal of Manpower, 37(5), pp. 878-899,

Radević, I. (2013) Digital Economy and Marketing Management (Podgorica: Faculty of Economy).

Rayner, J., Muldoon, L., Bayoumi, I., McMurchy, D., Mulligan, K. & Tharao, W. (2018) Delivering primary health care as envisioned: A model of health and well-being guiding community-governed primary care organizations, Journal of Integrated Care, 26(3), pp. 231-241,

Regmi, K., Naidoo, J., Greer, A. & Pilkington, P. (2010) Understanding the effect of decentralisation on health services: the Nepalese experience, Journal of health organization and management, 24(4), pp. 361-382,

Rule, J., Dunston, R. & Solomon, N. (2016) Learning and change in the redesign of a primary health care initiative, Journal of Workplace Learning, 28(7), pp. 451-467,

Saviano, M., Parida, R., Caputo, F. & Datta, S. K. (2014) Health care as a worldwide concern. Insights on the Italian and Indian health care systems and PPPs from a VSA perspective, EuroMed Journal of Business, 9(2), pp. 198-220,

Sciulli, N. (2008) Public private partnerships: an exploratory study in health care, Asian Review of Accounting, 16(1), pp. 21-38,

Sinisammal, J., Leviäkangas, P., Autio, T. & Hyrkäs, E. (2016) Entrepreneurs' perspective on public-private partnership in health care and social services, Journal of health organization and management, 30(1), pp. 174-191,

Sorrentino, M. & Simonetta, M. (2011) Assessing local partnerships: an organisational perspective, Transforming Government: People, Process and Policy, 5(3), pp. 207-224,

Steiner, R., Kaiser, C., Tapscott, C. & Navarro, C. (2018) Is local always better? Strengths and limitations of local governance for service delivery, International Journal of Public Sector Management, 31(4), pp. 394-409,

Walker, K. B. (1993) Centralized information systems services: managing the transition to decentralization, Industrial Management & Data Systems, 93(8), pp. 8-12,

World Health Organization. (2014) Health in all Policies (Helsinki: WHO).

World Health Organization and European health policy framework (2013) Health 2020 (Helsinki: WHO), available at:, (January 1, 2019).


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