Structural Changes and Subsidiarity in Italy and Britain
Edited by Alberto Brugnoli and Alessandro Colombo
Chapter 8: Innovation in governance: the involvement of social enterprises in health service delivery
The plural model of service delivery, as found in the Lombardy approach to governance, embodies tensions between devolution and abandonment, control and autonomy, decentralization and fragmentation, outputs and outcomes, delivery and purchasing, and efficiency and service. This chapter proposes that the tensions are generic when there is a shift in governance from hierarchies to markets and networks. The tensions are analysed by drawing on the example of devolved health service delivery in England since 1979.
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