题目: 重新定义意大利和美国的医疗政策状况 在意大利和美国这类高度去中心化政治体系中, 2008年全球金融危机最终让步于中央政府在政 策领域(包括医疗卫生) 所发挥的更为强健的影响力。在意大利国民卫生服务(Italian National Health Service) 中, 中央政府加强了成本控制, 对政策制定进行部分再中心化, 同时用高额赤字限 制自治区域。在美国占主导地位的私人医疗体系中, 金融危机促使美国于2010 年实行庞大的 联邦医疗改革。本文提出疑问: 金融危机和围绕医疗体系的模拟政府间背景, 这二者在诠释“两 种高度不同的医疗体系类型之间所发现的(再) 中心化”一事时扮演了何种角色? 笔者尤其使用 监管杂交(regulatory hybridization) (Rothgang et al., 2010) 这一概念, 和由施密德等人(2010) 以及Frisina Doetter等人(2015) 提出的医疗体系变化解释模型来检验相关证据。为此, 笔者探 索了根植于此模型中的功能主义和情境因素之间的关系。研究结果强调了修订监管杂交概念的 必要性, 从而允许将更多的分析聚焦于领土权力转变, 以理解去中心化医疗体系中的发展。

In highly decentralized political systems such as in Italy and the United States of America (US), the global financial crises beginning in 2008 gave way to a more assertive role of the central government in policy areas including health. In the Italian National Health Service, the central government intensified cost containment, partially recentralizing policy-making and limiting the autonomy of Regions with high deficits. In the predominantly private health system of the US, crisis ushered in dramatic federal health reform in 2010. This study asks, what role did financial crisis and an analogous intergovernmental context surrounding health care play in explaining the (re)centralization observed between two highly divergent health system types? We examine evidence particularly with a view to the concept of regulatory hybridization (Rothgang et al., 2010) and the larger explanatory model of health care system change put forth by Schmid, Cacace, Gotze and Rothgang (2010) and Frisina Doetter, Gotze, Schmid, Cacace and Rothgang (2015). In doing so, we explore the relationship between functionalist vs. contextual variables embedded within the model. Our findings highlight the necessity to revise the concept of regulatory hybridization to allow for greater analytical focus on territorial shifts in power to understand developments in decentralized health care systems.

Redefining the State in Health Care Policy in Italy and the United States / L. Frisina Doetter, S. Neri. - In: EUROPEAN POLICY ANALYSIS. - ISSN 2380-6567. - 4:2(2018 Oct), pp. 234-254. [10.1002/epa2.1050]

Redefining the State in Health Care Policy in Italy and the United States

S. Neri
Co-primo
2018

Abstract

In highly decentralized political systems such as in Italy and the United States of America (US), the global financial crises beginning in 2008 gave way to a more assertive role of the central government in policy areas including health. In the Italian National Health Service, the central government intensified cost containment, partially recentralizing policy-making and limiting the autonomy of Regions with high deficits. In the predominantly private health system of the US, crisis ushered in dramatic federal health reform in 2010. This study asks, what role did financial crisis and an analogous intergovernmental context surrounding health care play in explaining the (re)centralization observed between two highly divergent health system types? We examine evidence particularly with a view to the concept of regulatory hybridization (Rothgang et al., 2010) and the larger explanatory model of health care system change put forth by Schmid, Cacace, Gotze and Rothgang (2010) and Frisina Doetter, Gotze, Schmid, Cacace and Rothgang (2015). In doing so, we explore the relationship between functionalist vs. contextual variables embedded within the model. Our findings highlight the necessity to revise the concept of regulatory hybridization to allow for greater analytical focus on territorial shifts in power to understand developments in decentralized health care systems.
题目: 重新定义意大利和美国的医疗政策状况 在意大利和美国这类高度去中心化政治体系中, 2008年全球金融危机最终让步于中央政府在政 策领域(包括医疗卫生) 所发挥的更为强健的影响力。在意大利国民卫生服务(Italian National Health Service) 中, 中央政府加强了成本控制, 对政策制定进行部分再中心化, 同时用高额赤字限 制自治区域。在美国占主导地位的私人医疗体系中, 金融危机促使美国于2010 年实行庞大的 联邦医疗改革。本文提出疑问: 金融危机和围绕医疗体系的模拟政府间背景, 这二者在诠释“两 种高度不同的医疗体系类型之间所发现的(再) 中心化”一事时扮演了何种角色? 笔者尤其使用 监管杂交(regulatory hybridization) (Rothgang et al., 2010) 这一概念, 和由施密德等人(2010) 以及Frisina Doetter等人(2015) 提出的医疗体系变化解释模型来检验相关证据。为此, 笔者探 索了根植于此模型中的功能主义和情境因素之间的关系。研究结果强调了修订监管杂交概念的 必要性, 从而允许将更多的分析聚焦于领土权力转变, 以理解去中心化医疗体系中的发展。
Redefinir el estado en la polıtica de atencion de salud en Italia y los Estados Unidos En sistemas polıticos altamente descentralizados, como en Italia y los Estados Unidos de America (EE. UU.), Las crisis financieras mundiales que comenzaron en 2008 dieron paso a un papel mas asertivo del gobierno central en areas polıticas, incluida la salud. En el Servicio Nacional de Salud de Italia, el gobierno central intensifico la contencion de costos, recentralizando parcialmente la formulacion de polıticas y limitando la autonomıa de las regiones con altos deficits. En el sistema de salud predominantemente privado de EE. UU., La crisis marco el comienzo de una dramatica reforma federal de salud en 2010. El presente estudio pregunta que papel tuvieron la crisis financiera y un contexto intergubernamental analogo relacionado con la atencion medica para explicar la (re) centralizacion observada entre dos altamente divergentes tipos de sistemas de salud. Examinamos la evidencia particularmente con una vista al concepto de hibridacion regulatoria (Rothgang et al., 2010) y el modelo explicativo mas amplio del cambio en el sistema de salud propuesto por Schmid et al. (2010) y Frisina Doetter et al. (2015). Al hacerlo, exploramos la relacion entre las variables funcionalistas frente a las contextuales integradas en el modelo. Nuestros hallazgos destacan la necesidad de revisar el concepto de hibridacion regulatoria para permitir un mayor enfoque analıtico en los cambios territoriales en el poder y ası comprender los desarrollos en los sistemas de salud descentralizados.
Health care policy, U.S. politics, Italian politics, regulation, economic crisis (Polıtica sanitaria, polıtica estadounidense, polıtica italiana, regulacion, crisis economica) (关键词: 关键词:医疗政策, 美国政治, 意大利政治, 监管, 经济危机)
Settore SPS/09 - Sociologia dei Processi economici e del Lavoro
Settore SPS/04 - Scienza Politica
ott-2018
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/607672
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