Health Technology Assessment in Italy

Abstract

Italy has a national health service (SSN) dating to 1978. Italy's system of government is characterized by a rather high degree of decentralization of power, and the health system is likewise decentralized. Most of the responsibilities for health care have been ceded to the regions. The state retains only limited coordinating and supervisory powers. The state has a financial responsibility for the national health service, but state contributions are limited and expenditures in excess of this made by the region must be financed from other sources. Health reforms of 1992-93 aimed at making the regions more sensitive to the need to control aggregate expenditure and to monitor measures to promote efficiency, quality, and citizen-patient satisfaction. The diffusion of individual health technologies has been relatively uncontrolled in many regions in Italy, although tight central constraints on capital spending have contained diffusion of new technology. Regulation of placement of services is a planning function and is the responsibility of both the Ministry of Health and the regions. Health technology assessment (HTA) activities have been expanding since the early 1990s, but these activities tend to be untargeted, uncoordinated, and without priorities. Nonetheless, the principal actors in the SSN at national, regional, and local levels are becoming more sensitive to the need to apply criteria of clinical and cost-effectiveness and to be more rigorous in deciding what services to guarantee. There are reasons to be guardedly optimistic about the future of HTA in Italy.

Health Technology Assessment: An Essential Approach to Guide Clinical Governance Choices on Risk Management

“…During past decades, health care systems of industrialized countries have focussed on the problem of assuring health services to all citizens while reducing the allocation of economic resources (Fleurette and Banta, 2000;France, 2000;Granados et al, 2000;Perlett and Busse, 2000;Jorgensen and Hvenegaard, 2000).…”

The Italian health-care system

“…Although health technology assessment has expanded considerably since the early 1990s, this activity still tends to be unfocused, uncoordinated and to lack clearly defined priorities [40].…”

Diffusion and use of health technology assessment in policy making: What lessons for decentralised healthcare systems?

“…Within EU context, limited number of studies analysed the role of HTA in decentralised systems and showed that increasing autonomy assigned to the lower levels of government usually fosters the development of HTA programmes and activities at the regional level leaving the role of national level HTA bodies rather ambiguous [11][12][13][14][15][16]. In all the studies, regional models usually appear to be very different among them in terms of organization, institutional framework, stakeholders and aims.…”

“…In all the studies, regional models usually appear to be very different among them in terms of organization, institutional framework, stakeholders and aims. This heterogeneity is argued to be due not only to the different stages of implementation but also to different perception of the role of HTA within the context of the Regional Health Services [11,12]. Consequently, the results of HTA activities across regions can be profoundly different thus generating concern on national issues such as equity of access to healthcare technologies.…”