Health Care Policy for Better or for Worse? Examining NHS Reforms During Times of Economic Crisis versus Relative Stability

Economic crises are said to challenge welfare states by forcing them to cut expenditure by pursuing reforms aimed at cost containment and efficiency enhancing strategies. The oil crises of the 1970s and early 1980s, the global financial crisis of the early 1990s, and those of the 2000s marked acute economic phases rooted within a larger period of austerity politics in which welfare states have been observed to undergo major changes. However, the question has yet to be posed as to whether decisions affecting health care policy during acute economic crises are indeed fundamentally different than what can normally be observed over the longer period of cost containment policy. Moreover, where policy differences do exist between economic periods, are these differences consistent over time and across health care systems? To answer these questions we examine changes in regulation over the past four decades for two cases of National Health Services (NHS): England and Italy. More specifically, we examine the underlying causes for reforms in order to identify whether economic crises versus ‘system‐specific deficits’ (i.e. those deficits or sources for inefficiency lodged within the health care system itself) are the true causes for motivating change in and across NHS systems. Our findings establish that while acute economic crises create windows of opportunity for change, it is the interaction of system‐specific deficits and the role of ideas and political factors that largely condition the content and timing of reforms. Regarding the nature of reforms passed, our findings reveal consistency over time and across health care systems in the types of regulatory measures adopted and advanced.