The crisis of the State-nation led to a consolidation of sub-national levels of government. This reinforcement has conditioned recent developments in the welfare state, and particularly in health policy. With reference to the Italian case, the article illustrates the main changes brought into force by the reforms of 1992-93 and of 1999 in terms of the «regionalization» of the health system, and outlines the main steps that led to fiscal federalism, enhancing regional financial autonomy. The closing paragraph takes into consideration possible implications of the process of European integration and, more specifically, the adoption of the Open method of co-ordination on the evolution of the regional health systems.only subscribers can see the full article

The heavy burden of health spending on elderly care is common-place in the preoccupations of policy makers and politicians, and is constantly the focus of media attention. The attention on this subject is however rather ambivalent: stress is not placed on the «physiology» of growth in investments for a part of society that «obviously» expresses several needs and is entitled to corresponding rights; the objective complexity of the problem is presented in such a way as to make the solutions appear increasingly more difficult and not due, with the consequent rise in cultural, political and cognitive marginalisation. Analysing four model scenarios, operative solutions, feasible through a participatory way, are indicated at both the local and general levels.only subscribers can see the full article

The paper gives an overview of the historical evolution and characteristics of the s in Germany, the Uk and the Usa. The article also proposes an economic interpretation of differences between the three countries. Germany and the Uk, through different models, assure universal access to health services. In the Usa the residual role of public funding doesn’t manage to make up for shortcoming in the private sector, leaving almost a third of the population without any insurance or with insufficient insurance coverage. High health spending in the Usa, incrementing the diffusion of increasingly expensive new technologies and therapeutic approaches, can put universalistic systems under pressure. To maintain the present structure of European health systems, it is necessary to manage the diffusion of new technologies.only subscribers can see the full article