Skip to main content
Article thumbnail
Location of Repository

Power rather than path dependency?: The dynamics of institutional change under health care federalism

By Ana Rico and Joan Costa-i-Font

Abstract

Proposals for government decentralization rank high on the political reform agenda of health systems worldwide. Their impact on welfare state performance and change, however, is still under theoretical scrutiny. This article examines the impact of devolution on the construction of the Spanish National Health Service (NHS) in an attempt to shed some light on this debate. Against widespread claims of path dependency, we argue that the specific nature of the devolution model developed in Spain, given the more egalitarian sociopolitical structure that resulted from democratization, fostered policy innovation and institutional change. Consolidation of an NHS system was compatible with some regional diversity and apparently prevented the rise of signifi cant territorial inequalities. The Spanish case also suggests that policy change depends more on the distribution of social power than on institutions. It underlines the key role of financial and knowledge transfers vis-à-vis institutional reforms in effecting social change as well as the potential for state intervention in supporting the development of collective action resources by social groups

Topics: H Social Sciences (General)
Publisher: Duke University Press
Year: 2005
DOI identifier: 10.1215/03616878-30-1-2-231
OAI identifier: oai:eprints.lse.ac.uk:19394
Provided by: LSE Research Online
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://jhppl.dukejournals.org (external link)
  • http://eprints.lse.ac.uk/19394... (external link)
  • Suggested articles


    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.