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Citizen Engagement and the Challenge of Democratizing Health: An Italian Case Study

Participatory practices, within broader processes of rescaling and governance, have been identified as the solution to the “democratic deficit” in healthcare. Conversely, scholars have underscored how these practices could well be used for a contrary purpose, particularly in a top-down process. The first part of this paper outlines a theory-based evaluation framework oriented towards the analysis of institutional practices fostering citizens’ involvement in healthcare decision-making processes and how this involvement can act as a driver for the democratisation of the healthcare system. Following this interpretation, the second part of the paper analyses the new local governance structure adopted by Tuscany (Italy) in the healthcare sector, in particular the later stages of its adoption and diffusion and more than ten years after its institutionalisation. This leads us to identify certain crucial issues to be addressed when institutions promote re-visiting decision-making processes.