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The rise of the regulatory state in health care: a comparative analysis of the Netherlands, England and Italy

Published online by Cambridge University Press:  05 January 2012

Jan-Kees Helderman ,
Gwyn Bevan  and
George France
Jan-Kees Helderman*
Affiliation:
Assistant Professor in Public Administration, Department of Public Administration and Political Science, Institute of Management Research, Radboud University Nijmegen, The Netherlands
Gwyn Bevan
Affiliation:
Professor of Policy Analysis, Department of Management, London School of Economics and Political Science, United Kingdom
George France
Affiliation:
Associate, Institute for the Study of Regionalism, Federalism and Self-Government, National Research Council, Italy
*
*Correspondence to: Professor Jan-Kees Helderman, Department of Public Administration and Political Science, Radboud University Nijmegen, PO Box 9108, 6500 HK Nijmegen, The Netherlands. E-mail: [email protected]
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Abstract

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.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 1 , 05 January 2012 , pp. 103 - 124
Copyright
Copyright © Cambridge University Press 2012

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