Fiscal decentralization in the Italian NHS: What happens to interregional redistribution?

Health decentralization at a dead-end: towards new recovery plans for Italian hospitals

“…First, the decree does not address pre-existing managerial weaknesses. In this context, hospitals' General Managers are responsible for reducing deficits but, as reported by several sources, in the recent past many of them have been weak in managerial capacities and have been responsible for generating deficits [8,9,11,17]. Moreover, preliminary analyses of the financial statements of the hospitals across the country (results summarized in Table 2) have been based on heterogeneous financial reports, in which data reliability and comparability are not a foregone conclusion.…”

“…However, during the early years of the 21st century, a re-centralization process in European health systems has been observed, even if this trend has been limited only to certain functions specifically related to political and fiscal competences, while legislative powers over health sys- tem organization have remained at the regional level. The adoption of these measures has mainly been due to policymakers' concerns about the financial sustainability of healthcare systems, equity problems relating to population health outcomes and accessibility to services, and wide interregional differences resulting from devolution policies [5,[8][9][10][11][12]. This re-centralization process has favoured the diffusion of theories on the reversal of decentralization trends, with some authors claiming that the "new long wave of re-centralization" is a long-term structural shift in national health strategy [5].…”

Effects of health care decentralization in Spain from a citizens’ perspective

“…3 Nevertheless, we have to keep in mind that the bulk of the decentralization process occurred in 2002. 4 See, among many others, the collective work of Saltman et al (2007), the reviews of Jiménez-Rubio (2010) andandKolehmainen-Aitken (2005), the works of Bossert et al (2003) and Arreondo and Orozco (2005) for Latin American countries, the analyses of some African experiences by Jepsson and Okuonzi (2000) and Akin et al (2005), Tang and Bloom (2000) on China, Jiménez-Rubio et al (2008) and Zhong (2010) on Canada, Ferrario and Zanardi (2011) on Italy and Cantarero and Pascual (2006) on European Union countries.…”

Tax Mandates and Factor Input Use: Theory and Evidence from Italy

“…9 While the Italian regions have been in charge of managing and delivering health care services for over thirty years, the issue of the …nancing of regional health expenditures is still amply debated. During the late 1990s and early 2000s, the own revenue structure of the regions was deeply reformed with the aim of raising the health care budget share to be funded by own revenues and fostering regional government accountability (Bordignon and Turati, 2009;Ferrario and Zanardi, 2011). Moreover, the state and the regions agreed in principle on a system of rewards and sanctions to control excessive increases in expenditures and prevent the creation of budget de…cits.…”