Is Welfare Retrenchment Inevitable? Scope and Drivers of Healthcare Reforms in Five Spanish Regions During the Crisis

To what extent, in the context of severe economic crisis, do governments of the right and the left have room for manoeuvre to choose their fiscal consolidation paths? To what degree might this margin be broader in multilevel systems? The severity of the crisis suffered by Spain since 2007, combined with the significant scope of the powers and related expenditure capacities of the Autonomous Communities, make the Spanish regions a highly suitable case for controlled comparisons of fiscal adjustment policies and welfare reforms. Specifically examining healthcare retrenchment in the regions, we find that although the regional governments were all subjected to considerable budget constraints and were forced to cut social policies, they were also able to ensure a certain degree of leeway in selecting their individual healthcare retrenchment policies, in part by strategically utilising the multilevel institutions provided by the Spanish Autonomic State.