The concept of policy transfer may help to better reflect on policy processes. We used a well established policy transfer framework to review Italian health policy since the inception of the National Health Service in 1978, with a focus on the last two decades. We found that British and American policies (including policy instruments) have been widely referred to in the Italian debate and that transfer have been facilitated and mediated by policy experts and their epistemic communities. We also found that the framework suggested by Marsh and Dolowitz could be improved by revising the content of the two categories “ideas and attitude” and “ideology” because they cannot be adequately described by a process of transfer, and by introducing a specific category, possibly labelled “social technology or managerial technology”, to identify technical systems which incorporate codified knowledge and can be used for a variety of policy purposes. DRGs and accreditation systems would fall in this category. Concerning the Italian case we found that British health policy exerted some relevant influence but that the main role of international reference has been to provide feasibility checks and legitimization of policies endogenously developed. The Italian case shows also the interaction between policy transfer at the national and regional level, with diffusion of policy innovations occurring directly (in leading regions) and indirectly (in regions that tend to react or follow domestic experiences rather than international ones).
Endogeneity and policy transfer in the Italian National Health Service
FATTORE, GIOVANNI;LONGO, FRANCESCO;TEDIOSI, FABRIZIO
2011
Abstract
The concept of policy transfer may help to better reflect on policy processes. We used a well established policy transfer framework to review Italian health policy since the inception of the National Health Service in 1978, with a focus on the last two decades. We found that British and American policies (including policy instruments) have been widely referred to in the Italian debate and that transfer have been facilitated and mediated by policy experts and their epistemic communities. We also found that the framework suggested by Marsh and Dolowitz could be improved by revising the content of the two categories “ideas and attitude” and “ideology” because they cannot be adequately described by a process of transfer, and by introducing a specific category, possibly labelled “social technology or managerial technology”, to identify technical systems which incorporate codified knowledge and can be used for a variety of policy purposes. DRGs and accreditation systems would fall in this category. Concerning the Italian case we found that British health policy exerted some relevant influence but that the main role of international reference has been to provide feasibility checks and legitimization of policies endogenously developed. The Italian case shows also the interaction between policy transfer at the national and regional level, with diffusion of policy innovations occurring directly (in leading regions) and indirectly (in regions that tend to react or follow domestic experiences rather than international ones).
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