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The changing role of the state in the Italian healthcare system

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  • Frisina Doetter, Lorraine
  • Götze, Ralf

Abstract

The present study describes and explains the changing role of the state in the Italian healthcare system since the beginning of the 1970s, with a particular focus on developments following 1978 when the healthcare system was transformed from a social insurance system into a national health service. In order to address these changes in a systematic way, we track healthcare system development along three dimensions: regulation, financing, and service provision. With regard to regulation, we observe a relative retreat of the state due to decentralization processes and internal market mechanisms. Quantitative measures for the financing and service provision dimension also indicate a modest relative retreat of the state. Taking regional data into account, we identify a clear North-South-divide in the public/private mix of financing and service provision. Although the focus of the paper is to describe the changing role of the state in the Italian healthcare system, we also offer preliminary explanations. We seek to identify the role of exogenous shocks such as economic crises versus endogenous stressors specific to the healthcare system itself (i.e. inherent inefficiencies) on healthcare system change. Therefore, the paper aims to provide a tentative, yet dynamic account of healthcare system change that is both descriptive and explanatory.

Suggested Citation

  • Frisina Doetter, Lorraine & Götze, Ralf, 2011. "The changing role of the state in the Italian healthcare system," TranState Working Papers 150, University of Bremen, Collaborative Research Center 597: Transformations of the State.
    • Handle: RePEc:zbw:sfb597:150
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    References listed on IDEAS

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    1. Hacker, Jacob S., 2004. "Review Article: Dismantling the Health Care State? Political Institutions, Public Policies and the Comparative Politics of Health Reform," British Journal of Political Science, Cambridge University Press, vol. 34(4), pages 693-724, October.
    2. Streeck, Wolfgang & Thelen, Kathleen (ed.), 2005. "Beyond Continuity: Institutional Change in Advanced Political Economies," OUP Catalogue, Oxford University Press, number 9780199280469.
    3. Castles, Francis G., 2000. "The dog that didn't bark: economic development and the postwar welfare state," European Review, Cambridge University Press, vol. 8(3), pages 313-332, July.
    4. Bonoli, Giuliano & Palier, Bruno, 2000. "How do welfare states change? Institutions and their impact on the politics of welfare state reform in Western Europe," European Review, Cambridge University Press, vol. 8(3), pages 333-352, July.
    5. Elias Mossialos, 1997. "Citizens' Views on Health Care Systems in the 15 Member States of The European Union," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 109-116, March.
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    Cited by:

    1. Böhm, Katharina & Schmid, Achim & Götze, Ralf & Landwehr, Claudia & Rothgang, Heinz, 2013. "Five types of OECD healthcare systems: Empirical results of a deductive classification," Health Policy, Elsevier, vol. 113(3), pages 258-269.
    2. Böhm, Katharina & Schmid, Achim & Götze, Ralf & Landwehr, Claudia & Rothgang, Heinz, 2012. "Classifying OECD healthcare systems: A deductive approach," TranState Working Papers 165, University of Bremen, Collaborative Research Center 597: Transformations of the State.

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