Crisi economica, politiche di austerità e relazioni intergovernative nel Ssn. Dalla regionalizzazione al federalismo differenziato?

The austerity policies adopted in response to the economic crisis which started in 2008 had important consequences on the Italian NHS not only in terms of available resources but also in its governance. Cost containment policies, analysed in detail in the paper, aggravated the traditional NHS under-financing and understaffing compared to the main European countries. Moreover, after two decades of decentralization, these policies gave way to a complex change in the State-Regions relationships which could bring to a “differentiated federalism”. The central government – under pressure by the EU and financial markets – showed a more assertive role by partially re-centralizing the policy-making process and strictly limiting the autonomy of Southern Regions with high deficits. This latest trend did not involve Central and Northern Regions with limited deficits, which preserved their autonomy in the management of the healthcare system and, in some cases, ask for increased decentralization.