Explaining cross-regional policy variation in public sector reform: Institutions and change actors in the health sector in Spain

© 2016, © The Author(s) 2016. How can we explain cross-regional policy variation? That is, how can we understand different policy outcomes within similar institutional and organizational settings? Scholars have recently reflected on the new institutionalist explanatory pitfall involved in assuming a causality link between institutional factors and policy outcomes and argue that such link needs to rely on evidence from policy variables. On this line, recent contributions have built a causal model that links types of institutional change to types of actors' roles and strategies, within particular contextual and organizational scenarios that favor or hinder their emergence. This paper pursues this explanatory interest by applying this model to the analysis of how decision-making by two regional governments in Spain has led to different institutional and policy change outcomes in the same policy sector, namely, public management reform in healthcare. This study confirms the explanatory relevance of the model's key variables, but provides evidence of how some of them may be reinterpreted to provide a dynamic explanation of their influence on the process and outcome of institutional and policy change.