The rise of the regulatory state in health care: a comparative analysis of The Netherlands, England and Italy.
In a relatively short time, regulation has become a significant and distinct feature of how modern states wish to govern and steer their economy and society. Whereas the former 'dirigiste' state used to be closely related to public ownership (e.g. hospitals), planning (volume and capacity planning) and centralised administration (e.g. fixed prices and budgets), the new regulatory state relies mainly on the instrument of regulation to achieve its objectives. In this paper, we wish to relate the rise of the 'regulatory state' to the path-dependent trajectories and institutional legacies of discrete European health-care systems. For this purpose, we compared the Dutch corporatist social health insurance system, the strongly centralised National Health Service (NHS) of England and federal regionalised NHS system of Italy. Comparing these three different health-care systems suggests that it is indeed possible to identify a general trend towards the rise of the regulatory state in health care in the last two decades. However, although the three countries examined in this paper face similar problems of multilevel governance of networks of third-party payers and providers, each system also gives rise to its own distinct regulatory challenges.
Department of Public Administration and Political Science, Radboud University Nijmegen, PO Box 9108, 6500 HK Nijmegen, The Netherlands. j.helderman@fm.ru.nl
Jan-Kees
JK
Helderman
Gwyn
G
Bevan
George
G
France
D003431:Cross-Cultural Comparison; D003695:Delivery of Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration / Q000639:trends*; D004465:Economic Competition; D004739:England; D033161:Government Regulation; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends*; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence / Q000592:standards / Q000639:trends*; D007558:Italy; D009426:Netherlands; D017149:Private Sector; D017150:Public Sector; D013222:State Medicine / Q000331:legislation & jurisprudence / Q000592:standards / Q000639:trends*