Abstract

The austerity policies adopted in response to the economic and financial crisis had significant consequences on the Italian national health system, not only in terms of available resources but also in its governance at the regional level. Moreover, some Northern regions tried to preserve their autonomy in managing the healthcare system by promoting institutional reforms. In line with the approach of Streeck and Thelen (2005), the article focuses on the institutional reforms that have affected four regional health systems in the North and Centre of Italy: Lombardy, Veneto, Emilia Romagna and Tuscany. The empirical analysis – based on descriptive statistics and interviews with key informants – is centred on the process and the outcomes of reforms, aiming to isolate their most problematic aspects. What emerges is a kaleidoscope of strategies that changes both over time and across territories, albeit within a context of common structural pressures