Citizens' Engagement in the Health Sector Decision-Making across Europe

Health care systems in developed countries face a series of structural challenges over the next decade. These systemic pressures - at economical and social level - are well documented, as well the strategies adopted to face with them. The paper will focus on one of them, the new forms of participatory regulation in policy decision-making (citizens' engagment in network governance), which are presented as exit strategy, toghether with the spatial rescaling, from the democratic deficit in health-care. However, that this goal has been reached cannot be taken for granted, especially when one considers that these practices are often promoted by dominant players in the field.

In my research I've analysed the concrete applications to the concept of network governance, as a fruit of symbolic struggles among the various actors in the field of health to maximise their own position through the accumulation of capital. If over the last few years the legitimacy of the patients and public to have power has gained terrain, it is equally true that more often than one would like to admit these claims are used by the traditional holders of decisional power to strengthen their position.

By this perspective, the translation of the definition of participation in concrete forms can be taken as a dynamic account of the distribution of power within that certain field. The research analyses in a comparative way the practices adopted in European Countries - Denmark, France, Germany, Great Britain, Italy, Netherland, Spain and Sweden - comparing the structure of the networks and the “rules of the game” which, by defining the balances of power and reconciling various interests, function as filters for the subjects and modalities of policies.