The Hybridization of Healthcare Regulation: An Explanation in Cross-national Perspective

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

“…Accordingly, the Italian health care system represents a National Health Service (NHS) system type (cf. Frisina Doetter et al, 2015), whereas in the US a predominantly private insurance (PHI) system, within which two largescale public programs can nevertheless be found (i.e., Medicaid and Medicare) (see Cacace, 2010). In comparative terms, the Italian and U.S. cases represent two highly dissimilar health system types that responded to problem pressure with similar recourse to the regulatory apparatus of central government, however, to different ends: in Italy, recentralization efforts around the NHS aimed at better cost containment of regional spending on health care in order to compensate for larger economic deficits (Frisina Doetter et al, 2015).…”

“…Frisina Doetter et al, 2015), whereas in the US a predominantly private insurance (PHI) system, within which two largescale public programs can nevertheless be found (i.e., Medicaid and Medicare) (see Cacace, 2010). In comparative terms, the Italian and U.S. cases represent two highly dissimilar health system types that responded to problem pressure with similar recourse to the regulatory apparatus of central government, however, to different ends: in Italy, recentralization efforts around the NHS aimed at better cost containment of regional spending on health care in order to compensate for larger economic deficits (Frisina Doetter et al, 2015). Differently, in the US, the assertion of the central government's role as regulator was aimed at welfare state expansion that deemed necessary in light of ongoing health system failings compounded by hard economic times (Cacace, 2010;Frisina Doetter et al, 2015).…”

“…In comparative terms, the Italian and U.S. cases represent two highly dissimilar health system types that responded to problem pressure with similar recourse to the regulatory apparatus of central government, however, to different ends: in Italy, recentralization efforts around the NHS aimed at better cost containment of regional spending on health care in order to compensate for larger economic deficits (Frisina Doetter et al, 2015). Differently, in the US, the assertion of the central government's role as regulator was aimed at welfare state expansion that deemed necessary in light of ongoing health system failings compounded by hard economic times (Cacace, 2010;Frisina Doetter et al, 2015). Where the two systems converged was in the global economic climate of crisis, as well as in the contentious intergovernmental environment in which they generally operate-namely, the highly regionalized, quasi-federal political context surrounding health care in Italy since the late 1990s (France, 2008) and the long-standing tradition of federalism in the US that, particularly since the 1970s, has underwent renewed efforts to protect state authority against federal interventionism in economic and social policy (see e.g., Banks & Blakeman, 2018).…”

“…Following a logic similar to that of the Most Different Systems Design (MDSD) (Peters, 1998;Przeworski & Teune, 1970), we ask: what role did the financial crisis and intergovernmental context surrounding health care policy play in explaining the (re)centralization observed between two highly divergent health care system types? In order to answer this question, we analyze developments in the changing role of the state for each case during the post-2008 period, particularly with a view to earlier evidence of regulatory hybridization in line with Rothgang et al (2010), Schmid et al (2010) and Frisina Doetter et al (2015). This concept is based on the functionalist notion which holds that health care systems, in an effort to correct for system-specific deficits, adopt features from other system types to compensate for their own failings, thereby leading to regulatory hybridization.…”

“…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 and the larger explanatory model of health care system change put forth by Schmid, Cacace, G€ otze and Rothgang (2010) and Frisina Doetter, G€ otze, Schmid, Cacace and Rothgang (2015). In doing so, we explore the relationship between functionalist vs. contextual variables embedded within the model.…”