POLITICS, PUBLIC POLICY AND INTERGOVERNMENTAL ARRANGEMENTS: THE CASE OF HEALTHCARE IN ITALY AND SPAIN.

Under the effect of both exogenous and endogenous pressures, the territorial organization of political power has been deeply transformed in many Western States. In such a context, intergovernmental relations (IGR) have become increasingly salient, adding (or redefining) a new dimension of politics within multi-tiered domestic arenas. Different institutional tools for managing transformed intergovernmental relations (Intergovernmental Arrangements) are both theoretically possible and empirically observable. In this dissertation, the causes and the consequences of these institutional structures are investigated in two neo-regional countries – Spain and Italy – in one of the public policy sectors most affected by the process of territorial re-scaling: health care. Grounded on a historical new-institutional perspective and based on the adoption of a Most Similar System research Design (MSSD), the comparative analysis explores firstly why, in spite of similar levels of health care decentralization, Intergovernmental Arrangements at work in this policy field in these two countries differ on many respects; and, secondly, whether these differences can account for variations in the processes of intergovernmental policy-making channeled through them. The analysis shows the relevance, for understanding IGAs’ differences, of a set of factors at play in the early stages of decentralization: the degree of symmetry in the allocation of healthcare competences among subnational units as well as the kind of intragovernmental relations within the constitutive arenas; moreover, it suggests that the timing by which causal conditions come into play is a relevant question to be considered. By assessing the impact exerted by Intergovernmental Arrangements on IGR, and particularly on the kind of coalitions emerging in IGR processes, the analysis shows that, in line with previous studies in the field, the general question "do intergovernmental institutions matter?" can be positively answered.