Costanza Galanti

Abstract

In the last decades, and especially after the 2008 economic and financial crisis, EU countries’ healthcare systems have undergone dramatic changes. Most notably, austerity measures and privatisation processes have been furthered at the EU, national and local scales (Stan and Erne, 2021).

My research addresses two aspects that have been under-studied so far: the role of the EU’s new economic governance (NEG) interventions and that of trade union and grassroots mobilisations in shaping these transformations (2008-2022). The research does so by studying NEG interventions in the healthcare sector and countervailing mobilisations in two EU countries, Italy and Romania, with different healthcare systems, different positions in the EU and different activist landscapes. My research thus answers the following research questions: How have NEG interventions impacted the Italian and Romanian healthcare systems? How have Italian and Romanian unions and grassroots mobilisations responded to NEG interventions and their implementation in their respective healthcare sectors?

First, through policy analysis, I show how NEG interventions led to similar measures in the two countries: freezes or cuts to healthcare workers’ wages, decrease of staffing levels, restriction of union prerogatives, decrease in the number of hospital beds, promotion of private healthcare insurances, increase or introduction of co-payments to access public healthcare services and increased involvement of private actors in the delivery of the latter.

Second, through protest event analysis, I show that trade unions and grassroots mobilisations opposed, at times successfully, the implementation of NEG interventions; that they did so primarily by challenging national policymaking; and that mobilisations politicising the attack to healthcare labour and those politicising the attack to users’ access to healthcare services were usually organised separately from one another. Through the observation of healthcare mobilisations and interviews with activists and trade union officials, I then explained collective actors’ choices in terms of the scale of their mobilisations and the issues politicised, as well as what contributed to the successes and failures of healthcare collective action across the two countries and over time.

In conclusion, in this thesis, I show that the transformations of the Italian and Romanian healthcare systems were shaped by a conflict between NEG interventions favouring capital accumulation and countervailing collective action, and I provide explanations regarding the scale at which mobilisations occurred, the issues they politicised, as well as what contributed to their uneven success.