The Italian NHS at regional level: same in theory, different in practice

Garattini, Livio; Martini, Marco Badinella; Zanetti, Michele

doi:10.1007/s10198-021-01322-z

Cited by 18 publications

(8 citation statements)

References 11 publications

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“…The Italian National Health Service (NHS) provides universal coverage, and it is mainly funded by general taxation, with essential health care services that are largely free of charge at the time of delivery [41] . Particularly, according to Garattini et al 2021, 2017 [ 42 , 43 ], the Italian NHS has undergone massive decentralization from 1992, with the institutionalization of Regional Healthcare Systems (RHS) substantially autonomous and entitled to develop health strategies without necessary national endorsement. All RHSs are mandated to provide, among other essential levels of care to be publicly guaranteed, also maternal and childcare services aimed at protecting and promoting women's and children's health [ 44 , 45 ].…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of measures to preserve labour and childbirth companionship at the times of COVID-19 outbreak

Ferrari¹,

Bonciani²,

Corazza³

2023

Health Policy

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Section: Methodsmentioning

confidence: 99%

Effectiveness of measures to preserve labour and childbirth companionship at the times of COVID-19 outbreak

Ferrari¹,

Bonciani²,

Corazza³

2023

Health Policy

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“…This happens also in public health systems, which should provide universal health coverage in principle. However, this is often limited by funding schemes biased towards acute treatments and surgical or pharmacological therapies in practice (Garattini et al ., 2022 b ). The case of mental disorders is striking.…”

Section: Focus On Mental Health Carementioning

confidence: 99%

Including mental health care in a model of European health system

Garattini

Barbato

D’Avanzo

et al. 2023

Epidemiol Psychiatr Sci

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The management of a health system is a matter of economics and business administration because of the costs induced by goods and services delivered. Economics teaches us that the positive effects induced by competition in free markets cannot be expected in health care, which is a classic example of market failure from both demand and supply sides. The most sensible key concepts to refer for managing a health system are funding and provision. While the logical solution for the first variable is universal coverage through general taxation, the second one requires a deeper understanding. Integrated care is the modern approach that better supports the choice in favour of the public sector also for service provision. A major threat against this approach is dual practice legally allowed for health professionals, which inevitably raises financial conflicts of interest. An exclusive contract of employment for civil servants should be the sine qua non for providing public services effectively and efficiently. Integrated care is particularly important for long-term chronic illnesses associated with high levels of disability, such as neurodegenerative diseases and mental disorders, where the mix of health and social services needed can be very complex. Nowadays the growing number of community-dwelling patients with multiple physical and mental health needs is the major challenge for the European health systems. This happens also in public health systems, which should provide universal health coverage in principle, and the case of mental disorders is striking. In the light of this theoretical exercise, we strongly believe that a public National Health and Social Service should be the most indicated model for both funding and providing health and social care in modern societies. The big challenge of the common model of European health system here envisaged would be to limit the negative influences of politics and bureaucracy.

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“…So, alternate governments of opposite parties can inject inconsistent changes into health systems, which may often be superficial, but occasionally radical and thus deeply altering their functioning. A classical example of radical reform inducing dramatic changes was the inclusion at the end of the last millennium in the BNHS of the so called 'internal market' to foster competition among healthcare providers [1].…”

mentioning

confidence: 99%

“…Scotland and Wales) and to a larger extent in the INHS owing to the twenty regions (e.g. Lombardy, Tuscany, Sicily) [1]. Financial autonomy has allowed regionally elected politicians to develop substantially different healthcare strategies in the INHS, with no need of national endorsement.…”

mentioning

confidence: 99%