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Redefining the State in Health Care Policy in Italy and the United States
Author(s) -
Frisina Doetter Lorraine,
Neri Stefano
Publication year - 2018
Publication title -
european policy analysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.558
H-Index - 12
ISSN - 2380-6567
DOI - 10.1002/epa2.1050
Subject(s) - autonomy , health care , context (archaeology) , central government , government (linguistics) , health policy , political science , public administration , politics , health care reform , local government , geography , law , linguistics , philosophy , archaeology
In highly decentralized political systems such as in Italy and the United States of America ( US ), the global financial crises beginning in 2008 gave way to a more assertive role of the central government in policy areas including health. In the Italian National Health Service, the central government intensified cost containment, partially recentralizing policy‐making and limiting the autonomy of Regions with high deficits. In the predominantly private health system of the US , crisis ushered in dramatic federal health reform in 2010. This study asks, what role did financial crisis and an analogous intergovernmental context surrounding health care play in explaining the (re)centralization observed between two highly divergent health system types? We examine evidence particularly with a view to the concept of regulatory hybridization (Rothgang et al., 2010) and the larger explanatory model of health care system change put forth by Schmid, Cacace, Götze and Rothgang (2010) and Frisina Doetter, Götze, Schmid, Cacace and Rothgang (2015). In doing so, we explore the relationship between functionalist vs. contextual variables embedded within the model. Our findings highlight the necessity to revise the concept of regulatory hybridization to allow for greater analytical focus on territorial shifts in power to understand developments in decentralized health care systems.