 This study examined the relationship between decentralization and health outcomes in Europe. It found that decentralized healthcare provision was associated with higher levels of satisfaction with the healthcare system, but did not find any correlation between decentralization and self-reported health status. These results suggest that decentralization may not necessarily lead to better health outcomes, and further research is needed to determine how best to implement decentralization in order to achieve desired health outcomes. This article was authored by Pal E. Martinussen and Havard T. Ridland.