“The future of the health-care system mainly depends on the future of the country’s economy. If Italy overcomes the structural crisis and starts growing, cost-containment measures can be relaxed and the SSN can receive enough resources to meet the expectations of high quality and universal coverage. Overall, compared to other European countries, the SSN [Italy’s National Health Service] is already rather parsimonious; thus, longer periods of hard cost-containment policies may harm the delivery system and may induce popular calls for change. To deal with these serious fiscal constraints, the SSN may benefit from a better definition of the specific content of the benefit package it guarantees to citizens (mainly a more detailed definition of the LEA). A narrower definition of the SSN benefit package may help to concentrate resources in the most effective and cost-effective areas, maintain high quality in these essential services and, at the same time, provide space for complementary insurance schemes.

“Moving to the way the system is organized and services are delivered, three main issues deserve to be highlighted. The first concerns the relationship between politics and top management. The 1992/93 reforms limited the role of professional politicians in running SSN organizations and promoted the role of general managers. Indeed SSN organizations have experienced increasing professionalism at management level. Nevertheless, the appointment of general managers, health directors and administrative directors still appears to be mainly driven by local and political considerations. Interestingly, as general managers in the SSN tend to work almost exclusively in their region of residency, a national market for general managers has yet to materialize. Appointments based on political affiliation and without adequate consideration of professional qualities are frequent. These appointments limit the potential of general management as it makes it very difficult to manage ambitious tasks such as the closure of small hospitals, the development of new integrated systems of care or the redesign of hospitals.”

Source: Ferré F, de Belvis AG, Valerio L, Longhi S, Lazzari A, Fattore G, Ricciardi W, Maresso A. Italy: Health System Review. Health Systems in Transition, 2014, 16(4):1–168.

“A second major issue concerns primary care, which in Italy is still mainly based on solo-practice GPs or general paediatricians. This part of the SSN [National Health Service] has been only modestly addressed by reforms and policy initiatives, mainly aimed at promoting its organizational development based on GPs, paediatricians, nurses and other professionals working together in primary care teams. There is wide agreement that such models should be widely adopted. However, they require substantial changes that need to be well promoted, incentivized and managed. It is unlikely that new legislation will suffice to make these changes happen on the ground, also due to the lack of fresh resources to motivate professionals. More likely, regions and ASLs, adequately supported by regional and national frameworks, will be the key actors to manage changes in order to make primary care more inter-professional and collaborative than it is now. But again, different institutional and managerial capacities may result in very heterogeneous solutions across regions.”

Source: Ferré F, de Belvis AG, Valerio L, Longhi S, Lazzari A, Fattore G, Ricciardi W, Maresso A. Italy: Health System Review. Health Systems in Transition, 2014, 16(4):1–168.

“A third major issue concerns integration, de-integration and re-integration. Originally, the SSN [National Health Service] was designed to be a very integrated system with virtually all services under the control of Local Health Units (the former name of the ASLs). Partly due to the attempt to promote a quasi-market, partly due to the desire to better recognize the role of private providers and partly because the idea of the purchaser–provider split inspired Italian policy making, from the mid-1990s the SSN was partly de-integrated, mainly by making hospitals independent of ASLs. Currently, however, most regional policies seem to have returned to integration, namely through the re-attribution of some hospitals to ASLs, the concentration of purchasing activities in regional or supraorganizational entities and the enlargement of the size of ASLs. In addition, most regions have strengthened control over their providers. Overall, in the last 10 years regional authorities have increased their grip over provider organizations, which in turn, have lost most of their organizational autonomy. This trend towards re-integration is probably due to the general conditions of austerity and the search for savings. But at the same time, it is also due to the search for better integrated care pathways that can overcome barriers deriving from the involvement of different organizations in treating the same case. It is clear that patients increasingly need a variety of providers working in a co-ordinated way and that such co-ordination is essential to ensure quality of care as well as cost-containment. But how to experiment, evaluate and disseminate good practices in this respect is more an issue of policy design developed from the bottom, rather than the results of top-down policies that reduce the number of SSN organizations by making them larger.”

Source: Ferré F, de Belvis AG, Valerio L, Longhi S, Lazzari A, Fattore G, Ricciardi W, Maresso A. Italy: Health System Review. Health Systems in Transition, 2014, 16(4):1–168.

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 Sept. 20, 2022 by Doug McVay, Editor.