The first pandemic year: Continuity or change in two Italian Regional Healthcare Systems?

In recent years, social policy studies have increasingly focused on renewed State activism. The pandemic crisis called the State and central government to play an active role, even in highly decentralised healthcare systems. This involves two main issues: the importance of studying health policy at sub-national level and the analysis of the processes of institutional and organizational change. As to institutional change, literature on path dependency has been criticized for its deterministic view of the reproduction of institutions. More attention to the processual dimension is needed, as well as to the ways by which institutional arrangements are re-negotiated and translated into policies adopted under the pressure of a catastrophe. We hypothesise that, first, within the responses to pandemic, a process that develops through different temporal phases can be identified; second, that, in the initial phases, the weight of path dependency is stronger due to the proximity to the past and the lack of different tools that they still have to be forged. There could be limited innovations, according to which development trajectories are characterized by elements of continuity mixed with some changes. This would mean identifying, at least initially, incremental forms of change, for example by sedimentation (institutional layering) or by conversion even in the face of a strong impact event. The analysis of two regional regulation adopted (in Lombardy and Marche) to implement the national regulations, during 2020, shows that forms of institutional change through sedimentation or conversion can be identified.