---

“Overall, the last decade (before the COVID-19 pandemic) was dominated by an aggressive cost-containment strategy adopted at the national level and implemented by regions and SSN [National Health Service: Servizio Sanitario Nazionale] organizations. This strategy was based on two main types of measures. The first, directed at regions, forced them to adopt regional and local cost-containment measures. For example, the ceiling on pharmaceutical expenditure was expected to activate regional policies to reduce waste and to improve cost-conscious prescribing. In this respect, some regions (mainly in the north and centre) have been more active than others. In 2007, the government introduced a special regime for overspending regions that required the adoption and implementation of formal regional ‘recovery plans’ (piani di rientro). Since then, 10 out of the 21 regional health systems had to adopt these plans, which included actions to address the structural determinants of costs. Currently (2022) seven regions follow these plans. The overall effect of these recovery plans has been a drastic decrease in the yearly level of overspending. In 2019, the overall deficit of the SSN (SSN expenditure minus SSN funding) was close to zero. While these plans were effective in regaining control over expenditure, they also created concern⁵⁶ about their negative impact on the quantity and quality of services delivered to citizens. While a few studies found ambiguous evidence about the impact of recovery plans on health (see Bobini et al., 2019), a recent and very rigorous study by Arcà et al. (2020) found that regions that adopted recovery plans had worse outcomes in terms of amenable mortality. The second type of measure targeted SSN organizations directly. Here, the focus was on national personnel contracts, setting caps on the increase of specific expenditure items (e.g. for goods and services) and on containing prices of pharmaceuticals that are set at the at national level.”

---

“In terms of the Corruption Perceptions Index, Italy ranks 42nd out of 180 (Transparency International, 2022). Accounting for 13% of corruption cases (ANAC, 2019), the health sector is known to be particularly exposed to the risk of corruption, due to the large amount of public resources at its disposal and its network of national distribution channels, with an estimated loss of EUR 23.6 billion every year due to health expenditure waste, inefficiencies and corruption (the impact of the latter amounts to EUR 6.4 billion) (ISPE Sanità, 2014). According to the ISPE Sanità report, the main areas involved are medicine supplies, medical equipment and cleaning services.

“Thus, the Ministry of Health’s 3-year plans for prevention of corruption and transparency (the latest one released for 2021–2023) identify interventions aimed at preventing corruption risk factors, on the basis of the National Anticorruption Plan (Piano Nazionale Anticorruzione, PNA). According to the Plan, the main areas at risk are workforce recruitment, career progressions of health personnel, the assignment of public tenders, inspection of facilities, administrative surveillance and monitoring (Ministero della Salute, 2021k). Furthermore, the National Anticorruption Authority (Autorità Nazionale Anticorruzione, ANAC), the Ministry of Health and AGENAS have developed a monitoring system and a detailed roadmap to promote transparency in health care to reinforce the PNA. Specifically, the collaboration between AGENAS and ANAC has led to the establishment of a transparency portal, in which transparency indicators will be incorporated into the PNE which serves as one of Italy’s health system performance measurement programmes (see below) (AGENAS, 2017).

“Moreover, to safeguard citizens, if citizens (even a European citizen accessing Italian health care facilities according to EU Directive 24/11) are unsatisfied with the quality and safety of the treatment received, they can file a complaint directly with the facility’s Public Relations Office (URP) and consult the Health Service Charter that each health facility is required to have (Ministero della Salute, 2019g). In addition, there are Consultative and Conciliatory Commissions (Commissioni miste conciliative) (Natangelo, 2006) and Ombudsmen at regional level (Garante per il diritto alla salute) introduced by the Gelli Law. However, these authorities have only a role in steering health care facilities with weak advocacy powers.”

---

“Some policy measures that already have been implemented, such as simplifying bureaucracy and centralizing the procurement of medical devices or public tenders, also seek to increase transparency and accountability as well as to avoid duplication of tasks and reduce waste. The main example here is the concentration of purchasing activities in regional or supra-organizational entities through the establishment of UPCs [Unique regional Purchasing Centers], the enlargement of several local health authorities or the establishment of a new authority, an Authorities Zero, in charge of a number of administrative tasks, including central purchasing (see Chapter 2).”

---

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

---

Page last updated Feb. 1, 2023 by Doug McVay, Editor.