The paper is based on an empirical research about the reconfiguration of welfare within health field, across Italian regions. Health is a relevant policy issue, since it covers the 80-90% of the regional budget. Furthermore, it is a reliable indicator of the Italian regions governance capability to face with the challenges of welfare. New responses and models of policy are required, such as the integration of health and social care. On the one hand there is an increase of people with chronic diseases, who often need more extensive than intensive care; on the other hand, health and social policies seek to move increasingly towards a de-institutionalization and de-hospitalization of interventions, in order to maintain people in their community and home environments and also to contain costs. As this awareness grows, the practical translation of these principles faces difficulties, in part due to the fact that the social and health sectors are largely produced by different institutional, organizational and professional system and often competing with each other. In the implementation of policy innovation public bureaucracies, as it emerges in our comparative study across regions, play a relevant and increasing role. The public welfare area in fifteen years has especially undergone profound processes of privatization and managerialization: these changes should be strongly modifying patterns of public intervention and open the way to organizational models of post-bureaucracy. The underlying hypothesis is that the regions’ capacity to respond to the challenges presented by retrenchment measures depends not only on political-institutional factors (nature of government coalitions, political subcultures, the degree of inclusion of workers and businesses'' representatives, etc.), or on cultural factors (those policy trends and paradigms underlying different public policy decisions), but also, and above all, on the "organisational" factors (that is, the structural and functional characteristics of the administrative apparatus empowered to implement policy).
