Health care and long-term care (LTC) sit at the center of debates on the erosion of social rights and retrenchment of public provision. Both face shared pressures - fiscal constraints, demographic aging, and the growing role of private and quasi-market actors in functions once performed by the State - amounting to a de facto privatization of governance without a corresponding expansion of democratic accountability. Both are embedded in the territorial organization of the State, shaping who bears the political costs of reform.
This panel asks how multi-level governance arrangements - federalism, regionalism, decentralization - mediate the politics of health and LTC reform, and what this reveals about the resilience of democratic welfare governance. Three entangled dimensions organize the inquiry: governance (division of legislative and administrative powers); policy (coverage, eligibility, benefit design, quality standards); and politics (coalition formation, blame-avoidance, incentives shaping how sub-national actors negotiate entitlements) - including private and third-sector actors.
LTC is a revealing case: as a nascent, low-salience field straddling health and social-assistance competences, it exposes fault lines - center/periphery, public/private provision, universalism versus residual family responsibility - latent in institutionalized sectors. The panel joins scholarship on health-system federalism with LTC reform politics, spanning mature federal, intermediate regionalized, and fluid unitary systems undergoing regionalization.
We welcome papers addressing, among others:
- How do federal (e.g., Canada, US, Germany), quasi-federal (Spain), and regionalizing unitary (Italy) systems balance autonomy and uniformity? When does decentralization act as a "policy wedge" toward autonomy claims, as with Italy's regionalismo differenziato?
- How do sub-national governments differ in entitlement generosity, coverage, and design, and what role do fiscal instruments - equalization funds, block transfers, regional taxation - play in territorial equity?
- How do coalitions (unions, providers, third-sector organizations, sub-national governments) shape reform in low-salience arenas, and how do public attitudes constrain feasibility?
- How does private/third-sector involvement intersect with territorial governance, and what can comparative health/LTC federalism contribute to governance-resilience debates?
The panel welcomes diverse methods - case studies, process tracing, interviews, quantitative analysis - and any region, with interest in comparisons including Latin American systems (e.g., Brazil, Argentina, Mexico).