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This article analyses the long-term effects of privatisation and marketisation on the Italian regional health and social care systems. The research focuses on three Italian regions – Lombardy, Veneto and Lazio – which are representative of three different models of governance in these sectors. We examine the effects of privatisation and marketisation on the health and social care system by discussing how the regional health-care systems have managed the impact of the COVID-19 pandemic. We also shed light on the dramatic consequences of the pandemic crisis on employment levels and working conditions.

This article analyses the effects of austerity policies on local government in Italy. As in many EU countries, local government has been one of the main targets, within the wider public sector, of government policies to address the economic and sovereign debt crises, with a threefold effect: on local government employees, on local government employment relations institutions and practices, and on the provision of local public services. After a general overview of these policies, the cases of two Italian medium-large municipalities are analysed, showing the impact of austerity measures on the employment conditions of municipal employees and on the services provided by municipalities, as well as the influence of social dialogue on this impact. Variations between the two cases are highlighted, conditioned by the locally specific features of employment relations and actors' strategies.

AbstractSince the end of the 'golden age' of the welfare state, in Italy as in most European countries the reform of social protection has progressively emerged as one of the key issues in political debate. In this article we describe the evolution of the Italian welfare state over the past three decades, highlighting the distinctiveness of each decade. The analysis is mainly focused on three policy sectors: pension, health care and social assistance. After a policy stalemate, which lasted throughout the 1980s, far‐reaching reforms took place in the 1990s and in the early 2000s. We will argue that the sequence of reforms was the result of a change that had both endogenous and exogenous sources. In particular, relevant changes in the political system emerged after 1992 and international constraints on public expenditure and debt combined to stimulate co‐operation between the government and its social partners in the case of pension reforms and joint policy‐making between central government and the regions in health care and social assistance reforms. During the 2000s, actors continued to carry out agreed reforms to adjust the pension system, even though co‐operation was made difficult by the conflicts on the labour market front. In health and social care, which are matters devolved to the regions after the 1990s and the 2001 constitutional reform, central government and the regions sought to implement and stabilize new mechanisms for the governance of both sectors. Although conflict alternated with co‐operation, nevertheless both external and internal constraints induced actors, often reluctantly, to develop and institutionalize joint policy‐making.

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 theUS, 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 ofregulatory hybridization(Rothgang et al., 2010) and the larger explanatory model of health care system change put forth by Schmid, Cacace, Götze and Rothgang (2010) and Frisina Doetter, Götze, 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.