New Public Management Reform ideas and the remaking of the Italian and Danish health systems

This article explores the role of New Public Management (NPM) ideas in the reform of the Italian and Danish health systems. In particular, it investigates the arguments that have supported changes in their institutional and territorial dimensions. Whereas the institutional dimension is concerned with the allocation of authority between layers of government, the territorial dimension is related to the definition of the size of subnational governments. By adopting an argumentative approach to policy analysis and focusing on the role of ideas in policy formulation, the article shows how Italian and Danish policymakers have shaped the institutional and territorial changes that have taken place in their national health systems. Through document analysis and in- depth interviews with experts and decision-makers, we show that the relationship between changes in size and authority in relation to NPM ideas is not clear-cut. Whereas in Italy arguments about the need to change the allocation of authority were not tied to a discourse about the size of subnational governments and health agencies, in Denmark discourses about size and authority have run in parallel. The present study confirms previous findings and provides additional evidence suggesting that NPM ideas have spread widely through governments following a path of implementation that varies from one national context to another.