Italy: Health system review

The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, fi nancing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Various indicators show that the health of the Italian population has improved over the last few decades. Average life expectancy reached 77.6 years for men and 83.2 years for women in 2005, and the mortality rate among adults has fallen signifi cantly, as has the infant mortality rate. However, in almost all demographic and health indicators, there are marked regional differences for both men and women, refl ecting the economic imbalance between the north and south of the country. The main diseases affecting the population are circulatory diseases, malignant tumours and respiratory diseases, while smoking and rising obesity levels, particularly among young people, remain important public health challenges. Italy’s health care system is a regionally based National Health Service (Servizio Sanitario Nazionale (SSN)) that provides universal coverage free of charge at the point of service. The national level is responsible for ensuring the general objectives and fundamental principles of the national health care system. Regional governments, through the regional health departments, are responsible for ensuring the delivery of a benefi ts package through a network of population-based health management organizations and public and private accredited hospitals. Again, there is a considerable north–south divide in the quality of health care facilities and services provided to the population, and there are signifi cant cross-regional patient fl ows, particularly to receive high-level care in tertiary hospitals. Health care is mainly fi nanced by earmarked central and regional taxes. Each region is free to provide additional health care services if budgets permit, as long as they also deliver the basic package. However, regional budget defi cits historically have been a major problem and reform efforts since the 1990s have aimed, in part, to enforce balanced budgets. The most important state-level reforms from the beginning of the 1990s include: the devolution of health care provision to regional governments and the progressive strengthening of regional powers to deliver and fi nance health care; a parallel delegation of managerial authority to hospitals and local health enterprises; the establishment of the uniform basic package of health services that should be guaranteed to all citizens; the introduction of a national clinical guidelines programme to enhance the quality of health care; and the development of an electronic patient records system. Future challenges for the devolved Italian health care system include: overcoming the large variability in the quality of health care among regions; providing a national policy for the governance of patient mobility; the reorganization of primary health care; the integration of health care networks for emergency care, transfusions and transplants; and the integration of health, social care and palliative care.