Health system decentralization and recentralization in Italy: Ideas, discourse, and institutions

This paper explores the dynamics of health system decentralization and recentralization in Italy, investigating why and how the territorial organization of the health system has changed over time. Drawing from discursive and historical institutionalism, the explanatory framework revolves around the role of ideational and institutional factors. The methods include process tracing and interpretive-discourse analysis. Empirical material is drawn from documents and in-depth interviews to experts and decision-makers. Through the analysis of the reform trajectories in light of decentralization and recentralization processes, the paper shows that the territorial organization of the Italian health system has changed through a mechanism of gradual transformative change that I here call ideational and institutional bricolage, which involves the interplay between ideas, discourse, and institutions.