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. NeriCo-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.File | Dimensione | Formato | |
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