La régionalisation de la santé et la nouvelle gouvernance du Service National de Santé

In Italy decentralisation reforms started in the 1990s gave birth to different models of Regional Health Services, inspired by the principles of managed competition or managed cooperation. This essay describes these models and analyses their recent evolution, showing how divergence processes among Regions, prevailing in the 1990s, are now matched with convergence trends in the institutional arrangements. In order to attain cost-control and to create integrated networks of services, market mechanisms are reduced or minimized in their impact in favour of variable mix between top-down and negotiated planning. In this context, national policy making is increasingly negotiated between central government and Regions. Although considerable progresses, concerted policy-making still looks unsteady and inadequate to provide a satisfactory governance of a devolved NHS. So far, most of the efforts have been concentrated to financial problems, very serious in many Centre-Southern Regions, where they could cause a process of recentralisation.