Politics, Public Policy and Intergovernmental Arrangements

364 Pages·2014·5.13 MB·English

DIPARTIMENTO DI SCIENZE SOCIALI E POLITICHE
Graduate School in Social and Political Sciences
Ph.D. Program in Political Studies – 26th cycle

Politics, Public Policy and
Intergovernmental Arrangements:
the Case of Healthcare in Italy and Spain

Settore scientifico-disciplinare: SPS/04

Candidate:
Federico Razetti

Tutor:
Prof. Maurizio Ferrera

Ph.D. Program Coordinator:
Prof. Antonella Besussi

Committee:
Prof. Luigi Bobbio; Prof. Nicole Bolleyer; Prof. Nicola Pasini

th
October 24 , 2014

A. A. 2013-2014
Contents
Introduction 1
The territorial rescaling of the State and the redefinition of domestic
Intergovernmental Relations: common trends, different solutions,
different impacts? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
The Logic of inquiry and the research strategy . . . . . . . . . . . . . . . 3
Explaining IGAs’ variety . . . . . . . . . . . . . . . . . . . . . . . . 4
Assessing the impact of IGAs on IGR . . . . . . . . . . . . . . . . . 5
Taking a new-institutional perspective . . . . . . . . . . . . . . . . . . . 7
Healthcare policy in Italy and Spain . . . . . . . . . . . . . . . . . . . . 9
Research sources and techniques . . . . . . . . . . . . . . . . . . . . . . . 11
General outline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1 Conceptual, Analytical and Theoretical Foundations 14
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.2 The historical background: devolution of powers in Western Euro-
pean countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.3 Increasing interactions between levels of government . . . . . . . . . 20
1.4 Competinganalyticalperspectives: IntergovernmentalRelations(IGR)
and Multilevel Governance (MLG) . . . . . . . . . . . . . . . . . . 23
1.5 Defining building-block concepts . . . . . . . . . . . . . . . . . . . . 28
1.5.1 Intergovernmental Relations (IGR) . . . . . . . . . . . . . . 28
1.5.2 IntergovernmentalArrangements(IGAs)andExecutiveFed-
eralism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
1.6 IGR and IGAs as dependent variables: main hypotheses . . . . . . 39
1.6.1 The polity: the role of the institutional-constitutional struc-
ture of the state . . . . . . . . . . . . . . . . . . . . . . . . . 40
1.6.2 The politics: partisan congruence . . . . . . . . . . . . . . . 45
1.6.3 The policy: the conflict potential . . . . . . . . . . . . . . . 48
1.6.4 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
1.7 IGR and IGAs as independent variables: main hypotheses . . . . . 53
i
1.7.1 The impact of IGAs on IGR outputs: quantity and quality
of agreements . . . . . . . . . . . . . . . . . . . . . . . . . . 54
1.7.2 The impact of IGAs on IGR processes: policy learning, ac-
tors’ coalitions and conflict lines . . . . . . . . . . . . . . . . 56
2 Intergovernmental Arrangements in Italy: Historical Evolution
and Current Setting 62
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
2.2 The vertical dimension of IGRs and IGAs . . . . . . . . . . . . . . 63
2.2.1 The constitutional framework . . . . . . . . . . . . . . . . . 63
2.2.2 Emergence and evolution of Executive Federalism . . . . . . 64
2.2.3 Powers, organization and functioning of the State-Regions
Conference . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
2.3 The horizontal dimension of IGRs and IGAs . . . . . . . . . . . . . 99
2.3.1 Emergence and evolution of Executive Federalism: the Con-
ference of the Regions . . . . . . . . . . . . . . . . . . . . . 100
2.3.2 Organization and functioning of the Conference of the Regions102
2.4 The interactions between the vertical and the horizontal dimensions 111
3 Intergovernmental Arrangements in Spain: Historical Evolution
and Current Setting 115
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
3.2 The vertical dimension of IGRs and IGAs . . . . . . . . . . . . . . 116
3.2.1 The constitutional framework . . . . . . . . . . . . . . . . . 116
3.2.2 Emergence and evolution of executive federalism: the Sec-
toral Conferences . . . . . . . . . . . . . . . . . . . . . . . . 117
3.2.3 Powers, organization and functioning of healthcare policy
Conferences: the CISNS and the CPFF . . . . . . . . . . . . 128
3.2.4 A new vertical, generalist IGA: the Conference of the Pres-
idents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
3.2.5 The Bilateral Cooperation Commissions . . . . . . . . . . . 154
3.3 The horizontal dimension of IGRs and IGAs . . . . . . . . . . . . . 157
4 Comparing Italian and Spanish IGAs: Why So Different? 161
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
4.2 Italian and Spanish IGAs compared . . . . . . . . . . . . . . . . . . 163
4.3 Looking for an explanation . . . . . . . . . . . . . . . . . . . . . . . 166
4.3.1 Ruled out explanatory conditions . . . . . . . . . . . . . . . 166
4.3.2 Potentially relevant explanatory conditions . . . . . . . . . . 171
4.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
ii
5 IGR and the Politics of Health Policy Making 219
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
5.2 Conflict lines and actors’ coalitions in IGR . . . . . . . . . . . . . . 220
5.3 A General overview . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
5.3.1 Italy: a subnational level opposition . . . . . . . . . . . . . . 225
5.3.2 Spain: government vs. opposition . . . . . . . . . . . . . . . 231
5.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
6 Two Case Studies: The 2003 Italian "Fiuggi Agreement" and the
2005 Spanish Health Financing Agreement 262
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
6.2 Case selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
6.3 Italy: the 2003 "Fiuggi Agreement" . . . . . . . . . . . . . . . . . . 266
6.3.1 Some preliminary remarks . . . . . . . . . . . . . . . . . . . 266
6.3.2 The IGR decision-making process . . . . . . . . . . . . . . . 269
6.4 Spain: the 2005 Health Financing Agreement . . . . . . . . . . . . . 279
6.4.1 Some preliminary remarks . . . . . . . . . . . . . . . . . . . 279
6.4.2 The IGR decision-making process . . . . . . . . . . . . . . . 280
6.5 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Conclusions 301
A Main IGAs: A Comparative Overview 307
A.1 US . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
A.2 Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
A.3 Australia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
A.4 Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
A.5 Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
A.6 Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
A.7 Belgium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
A.8 UK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
B Methodological Notes 323
C Conferenza delle Regioni 327
Bibliography 329
iii
List of Figures
1 The analytical focus shift. . . . . . . . . . . . . . . . . . . . . . . . 4
2 Comparative research design strategies. . . . . . . . . . . . . . . . . 6
2.1 Trend of sectoral legislative acts conferring new tasks to the State-
Regions Conference (1984-2005). . . . . . . . . . . . . . . . . . . . . 75
2.2 State-Regions Conference: organizational structure. . . . . . . . . . 88
2.3 State-Regions Conference: number of meetings (1984-2012). . . . . 91
2.4 State-Regions Conference: number of acts passed (1990-2012). . . . 95
2.5 State-Regions Conference: number of acts passed per kind (1990-
2012). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
2.6 State-Regions Conference: percentage of acts related to health pol-
icy (2002-2012). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
2.7 Conference of the Regions: organizational structure. . . . . . . . . . 107
2.8 Conference of the Regions: number of meetings (1998-2012). . . . . 109
2.9 Vertical and horizontal dimensions of Italian IGAs . . . . . . . . . . 112
3.1 CISNS: organizational structure. . . . . . . . . . . . . . . . . . . . . 140
3.2 CISNS: number of meetings (1987-2012). . . . . . . . . . . . . . . . 142
3.3 CISNS: number of agreements (1987-2012). . . . . . . . . . . . . . . 144
3.4 CPFF: number of meetings (1981-2012). . . . . . . . . . . . . . . . 148
6.1 Italy2003: Formalintergovernmentaldecision-makingprocess(main
steps). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
6.2 Spain2005: Formalintergovernmentaldecision-makingprocess(main
steps). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
C.1 Example of internal procedures: main steps . . . . . . . . . . . . . 328
iv
List of Tables
1.1 The Federal-Unitary continuum . . . . . . . . . . . . . . . . . . . . 20
1.2 Types of MLG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
1.3 Main multilateral IGAs in federal and quasi-federal western countries. 36
1.4 Polity factors: main Hypotheses . . . . . . . . . . . . . . . . . . . . 46
1.5 Politics factors: main hypotheses . . . . . . . . . . . . . . . . . . . 49
1.6 Policy factors: main hypotheses . . . . . . . . . . . . . . . . . . . . 52
2.1 Main vertical Italian IGAs: date of establishment and composition. 71
2.2 State-Regions Conference: meetings with health policy items on the
agenda. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
2.3 Conference of the Regions: meetings with health policy items on
the agenda. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
3.1 Sectoral Conferences established between 1980 and 1992. . . . . . . 123
3.2 Sectoral Conferences established between 1993 and 1997. . . . . . . 127
3.3 Sectoral Conferences established between 1999 and 2012. . . . . . . 129
3.4 CPFF Working Groups: number of meetings (2003-2012). . . . . . . 149
3.5 Bilateral Cooperation Commissions: year of foundation. . . . . . . . 155
4.1 Italian and Spanish IGAs compared. . . . . . . . . . . . . . . . . . 164
4.2 Asymmetry among Spanish AACC in health competences. . . . . . 182
4.3 Devolution of health competences to the Spanish AACC. . . . . . . 183
4.4 Regional and Central Governments Configurations in Italy (1970-
1978). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
4.5 Regional and Central Governments Configurations in Italy (1980-
1986). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
4.6 Regional and Central Governments Configurations in Italy (1988-
1992). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
4.7 Types of Regional Governments in Spain (1980-2011). . . . . . . . . 194
4.8 Regional and Central Governments Configurations in Spain (1984-
1994). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
v
4.9 Regional and Central Governments Configurations in Spain (1996-
2002). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
4.10 Regional and Central Governments Configurations in Spain (2004-
2012). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
4.11 Regional and Central Governments Configurations in Italy (1996-
2012). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
4.12 Regional Governments in Italy and Spain: Horizontal Ideological
Incongruence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
5.1 State-Regions Conference – Central Government-Regions interac-
tion modalities: major conflicts (2002-2012). . . . . . . . . . . . . . 232
5.2 CISNS – Central Government-Autonomous Communities interac-
tion modalities: major conflicts (2002-2012). . . . . . . . . . . . . . 241
5.3 CPFF–CentralGovernment-AutonomousCommunitiesinteraction
modalities: major conflicts (2002-2012). . . . . . . . . . . . . . . . . 248
5.4 Conference of the Presidents – Central Government-Autonomous
Communities interaction modalities: major conflicts (2004-2012). . . 252
6.1 Case selection: Italy 2003 and Spain 2005 compared. . . . . . . . . 267
6.2 Italy 2003: chronology . . . . . . . . . . . . . . . . . . . . . . . . . 279
6.3 Spain 2005: chronology . . . . . . . . . . . . . . . . . . . . . . . . . 294
vi
List of Abbreviations
IGA Intergovernmental Arrangement
IGR Intergovernmental Relations
NHS National Health Service
AACC Autonomous Communities
CISNS Consejo Interterritorial del Sistema Nacional de Salud
CPFF Consejo de Política Fiscal y Financiera de las Comunidades
Autónomas
INSALUD Instituto Nacional de la Salud
LOAPA Ley Orgánica de Armonización del Proceso Autonómico
LOFCA Ley Orgánica de Financiación de las Comunidades Autónomas
LRJ-PAC Ley de Régimen jurídico de las Administraciones Públicas y del
Procedimiento Administrativo Común
Italian Political Parties (1970-1992)
ADP Autonomisti Democratici Progressisti
DC Democrazia Cristiana
DP Democratici Popolari
FV Federazione dei Verdi
PCI Partito Comunista Italiano
PLI Partito Liberale Italiano
PRI Partito Repubblicano Italiano
PSdAZ Partito Sardo d’Azione
PSDI Partito Socialdemocratico Italiano
PSI Partito Socialista Italiano
PSIUP Partito Socialista Italiano di Unità Proletaria
SVP Südtiroler Volkspartei
UV Union Valdôtaine
UVP Union Valdôtaine Progressiste
vii
Spanish Political Parties
AIC Agrupaciones Independientes de Canarias
CC Coalición Canaria
CDN Convergencia de Demócratas de Navarra
CiU Convergència i Unió
EA Eusko Alkartasuna
ERC Esquerra Republicana de Catalunya
ICV Iniciativa per Catalunya Verds
IU Izquierda Unida
PA Partido Andalucista
PAR Partido Aragonés
PNV Partido Nacionalista Vasco
PP Partido Popular
PR Partido Riojano
PRC Partido Regionalista de Cantabria
PSM Partido Socialista de Mallorca
PSOE Partido Socialista Obrero Español
UM Unión Mallorquina
UPN Unión del Pueblo Navarro
UV Unión Valenciana
UPCA Unión para el Progreso de Cantabria
viii
Acknowledgements
During the time of writing this dissertation I received support and intellectual guidance
from many people. Conversations and exchanges with my supervisor always provided
mewithpreciousandstimulatinginsightsandadvices,helpingmeinthe(bumpy)search
for "reflective equilibrium". I am particularly grateful to all those who took an interest
in my research endeavor and decided to kindly devote part of their time to contribute to
my work, by answering my (very long) questions, by suggesting me paths to be followed,
and by providing me with useful research material. Last but not least, a special thank
goes to those who cheered me up every time I have been in need of support: my family,
which always encouraged me and whose patience I definitively put to the test, as well
as my friends, mates and colleagues, who shared with me all the ups and downs of the
last years.