Health economics

The governance and efficiency of health systems

Since 1978, the year of the introduction of the three ‘health reforms’, Italian health legislation has undergone major changes. The creation of the Italian NHS has in fact changed substantially both in the organizational structure and the operating methods of the healthcare system. These changes have also affected the way in which the policy of regional healthcare is addressed and on the bodies responsible for its structure and activities; the current system is characterized by a significant amount of decentralized decision-making as compared to the previous system which was centralized at state level.

Nevertheless, it has not always been possible to increase efficiency when delivering performance which is consistent with the demand requirements and what is more, healthcare expenditure remains one of the most problematic items in regional budgets and is certainly one of the main challenges that will be played for in the ‘game’ of federalism in Italy. Certainly there is no lack of cases of excellence in the Italian NHS, but some questions remain, such as; how to increase the level of efficiency in a ‘general sense’ without compromising the level of effectiveness in the provision of the services, how to promote the adoption of a managerial approach based on the achievement of goals, while preserving the constitutional dictum that ‘safeguards healthcare as a fundamental right of the individual and also the interest of the community’. To this end, the measurement of results (performance), is essential, as it is an indispensable indicator for guiding government policy-making.

In more detail, the measurement of the NHS in terms of absorbed resources is fundamental. Up to now we have seen a single measurement of each individual citizen ‘weighted’ in consideration of certain parameters, while at the moment it is currently close to standard cost financing. The focus is more on self-governance, rather than being limited to simply hospital care, observing the system as a whole, as well as modelling the healthcare system. The research, the results of which will be presented at this conference, aims to provide a contribution and a clarification of the scope of the definition and of the application of the measurement of the performance of the Italian NHS.