Assessing the Multiple Streams Framework in Quasi-federal Contexts: Decision-making and Policy Shift in Health Management in Catalonia, 2003-2007

The multiple streams framework has mainly been applied to decision-making processes involving one government level. The assessment of this framework would gain insight if it included the analysis of decision-making in decentralized states. This paper analyzes decision-making by sub-central governments, that is, how regional political autonomy is exercised under quasi- or federal constraints. The comparative literature on the impact of decentralization on the welfare state highlights Spain as an example of how political autonomy leads to the emergence of regional welfare regimes. But why have Autonomous Communities’ governments made different policy options? This paper analyzes a case study on a shift in health policy in Catalonia over the past decade, with a particular focus on a legislative decision that changed health management of public provision. This is an exploratory case study to help understand the factors that influence decision-making by sub-central, politically autonomous governments within a quasi-federal institutional framework. The fact that Catalonia has a strong nationalist stand leads us to include factors such as the territorial financing model and the evolution of the multi-level political context in the use of decision making models such as Kingdon (1984) and Baumgartner and Jones (1993).