The modernisation of the welfare state in Italy : dynamic conservatism and health care reform, 1992 to 2003
An institutional pattern of administrative inertia and resistance has traditionally characterised the reform of the Italian State. It is widely held that the historical development of the state has contributed to this immobilisme. The effect of the Italian system of party government on bureaucratic autonomy is also blamed for the failure (until recently) of attempts to reform the Italian state. However, definite changes affecting welfare administration in Italy reveal a radical departure from the status quo, as a result of particular reform mechanisms and the strategies of elites in handling blockages during the process of legislative implementation of delegating laws designed to introduce ambitious reform programmes. 'Dynamic conservatism' is the novel theoretical approach elaborated here to study policy change in such stalled administrative systems, and it offers an explanation of how it becomes possible to break historically determined immobilisme. The case of healthcare reforms in Italy in the 1990s has marked an impressive departure from traditional administrative practice. The thesis argues that two key innovations have been accomplished: first, the emergence of public managers charged with extensive policy leadership at the top of regional welfare administration, increasingly legitimised by expertise and technical knowledge rather than political entrepreneurialism; secondly, the reconfiguration of traditional centre- periphery relations, triggered by the territorial disturbance caused by regionalisation. The consolidation of policy change, underpinned by the paradigm of the entrepreneurial state, was most noticeable at regional level. Such change was achieved, however, only by handling beforehand two major blockages: first, the opposition of political parties during the parliamentary process to the reconfiguration of the relationship between politics and administration; secondly, the adversarial response of interest groups to policy change.