ABSTRACT
The argument developed in this study is that understanding subnational governance is a vital but largely absent element in comparative health care policy analysis. It is vital because descriptions at the national level using traditional archetypes, such as the Beveridge and Bismarck models, fail to capture differences in subnational governance that have emerged over the past 20 years. At the national level, both Italy and the UK follow the Beveridge model, and in these countries there were attempts, in the 1990s, to introduce provider competition across the regions of Italy (France and Taroni 2005) and the countries of the UK (Bevan and Robinson 2005). Although this model is still being tried in Lombardy (Brenna 2011) and England (Boyle 2012); the region of Tuscany (Nuti et al. 2013) and the country of Scotland (Steel and Cylus 2012) have abandoned provider competition for systems of performance management. Theories of comparative federalism ought to enable us to provide richer descriptions of subnational systems of governance and hence more powerful comparative health care policy analysis.
