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DECENTRALIZATION AND MANAGEMENT AUTONOMY? EVIDENCE FROM THE CATALONIAN HOSPITAL SECTOR IN A DECENTRALIZED SPAIN GuillemLópezCasasnovas,DavidMcDaidandJoanCostaFont ABSTRACT The organization of inpatient care provision has undergone significant reform in many southern European countries although the success of the underlying incentives relies on the institutional design with respect to achieving efficiency and promoting policy innovation without harming the essential principle of ‘equal access for equal need’ that grounds National Health Systems (NHS). This article explores some of the specific organizational developments of decentralizations structures drawing from the Catalonian experiences. We find that the coincidence of both managerial and political decentralization is associated with the mergence of organization and policy innovation resulting from policy experimentation at the regional level might be an additional feature to take into account when examining the ben efits of decentralization. INTRODUCTION Theworldinwhichpublicmanagersfunctionisrapidlychangingandvastlydifferent Recentpolicydevelopmentsintheorganizationofpubliclyfundedhealthcareservices indicate a shift towards more decentralization at an organizational level, whilst promotingmoremanagementflexibilityandautonomy.Thisshiftisreliantonanewset of tools derived from principleagent theories for the transformation of public sector management(GrayandJenkins,1995)beingapplicabletothehealthcarearenainthose countrieswherethehealthsystemispubliclyfinancedandorganized.Decentralization and deregulation are increasingly highlighted as instruments for providing more accountablegovernancearrangements,andultimatelyinattemptingtoobtainefficiency improvements1. Indeed, decentralized organization