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

Rico, Ana and Costa-i-Font, Joan (2005) Power rather than path dependency?: The dynamics of institutional change under health care federalism. Journal of Health Politics, Policy and Law, 30 (1). pp. 231-252. ISSN 0361-6878

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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.

Item Type: Article
Official URL: http://jhppl.dukejournals.org
Additional Information: © 2005 Duke University Press
Library of Congress subject classification: H Social Sciences > H Social Sciences (General)
Sets: Departments > European Institute
Research centres and groups > LSE Health
Rights: http://www.lse.ac.uk/library/usingTheLibrary/academicSupport/OA/depositYourResearch.aspx
Date Deposited: 15 Jul 2008 08:33
URL: http://eprints.lse.ac.uk/19394/

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