Regulating unsecure healthcare systems in times of crisis. Italy and Poland compared

Economic and financial crisis and the pressures exerted at international level may be an important factor promoting both incremental and structural changes in the health care systems, but the specific responses seem to be highly affected by the internal political conditions. In Italy, current welfare reforms, including the NHS, have been propelled by, on the one hand, the economic crisis, the pressure exerted by financial markets on countries with high sovereign debt and the EMU constraints, on the other, by the crisis of the party system and the political weakness of many regional governments, which opened new policy windows. In Poland, since 1989 healthcare has been undergoing structural reforms in a largely endogenous process but the recent legislation regulating the market for reimbursed pharmaceuticals is also a response to the transparency directive and an attempt to contain costs of publicly financed healthcare in times of economic austerity. In Italy, after de-centralisation in healthcare in 1990s, the emerging re-centralisation is a response to the regions’ incapability to keep health expenditure under control. In Poland, the government indirectly used the crisis as a card in negotiations with the producers and distributors of pharmaceuticals; moreover, the pharmaceuticals legislation was prepared unilaterally by the government, ignoring inputs from other stakeholders (e.g. experts, professionals). Thus both in the Italian and the Polish case recent reforms have strengthened the position of the central government vis-à-vis other stakeholders and market players, which is consistent with the post-crisis policies in Europe in other areas like employment relations.