Open Access Journal

ISSN: 2183-2463

Article | Open Access

Multi‐Level Governance Feedback and Health Care in Italy in the Aftermath of Covid‐19

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Abstract:  At the crossroads of EU studies and public policy analysis, a vast literature identifies global crises as one of the main triggers of change. The present article provides a test of this hypothesis in the case of health care in the aftermath of the pandemic crisis that hit Europe between 2020 and 2022. We use Italy as an extreme case, where both the magnitude of the Covid-19 outbreak and the effect of the pre-existent domestic cost-cutting strategy potentially opened a large window of opportunity for change. Through the lenses of historical institutionalism, we aim to shed light on policy change in multi-level health governance systems. Evidence collected through semi-structured interviews, triangulated with secondary sources, proves that the governance of health care in Italy has experienced no paradigmatic change. We show that “governance feedbacks” have reinforced pre-existing dynamics and inhibited more radical forms of change.

Keywords:  Covid‐19; EU governance; feedback; health care; historical institutionalism; Italy; policy change



© David Natali, Emmanuele Pavolini, Andrea Terlizzi. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 license (, which permits any use, distribution, and reproduction of the work without further permission provided the original author(s) and source are credited.