This process of expansion has been necessitated by the nature of insurance-based systems (in contrast to universalist ones), wherein access to healthcare was historically derived from occupational status and benefits and contributions frequently varied depending on occupation. Even more importantly, however, those who were outside of the labour market (e.g. the unemployed, the informally employed, or caregiving women with atypical employment patterns) have often fallen through gaps in the system. Within this context, some countries (such as France) have dealt with these issues by slowly bringing new groups into the social insurance fold – even standardising benefits across certain groups; others (such as Italy) have instead opted for a complete transformation of their systems, attempting to implement NHS-style healthcare.
This essay will examine, in a primarily qualitative manner, the various critical junctures since the Second World War that have culminated in divergent outcomes in France and Italy. In doing so, I intend to explore the roles that parties and social partners have played, with an eye to the ways in which their respective actions have been shaped by various institutional factors. Overall, through this investigation I hope to contribute to the study of macro level processes at work in the extension and standardisation of welfare benefit coverage from welfare state “insiders” to the population as a whole.
