Budget cuts and regional disparities increase the pressure on the Italian health system

Coinciding with the Italian Presidency of the European Union’s Council of Ministers, the new HiT health system review on Italy has just been published. 

Faced with rising regional deficits and austerity budgets focused on reduced public spending, the Italian National Health Service has been grappling with a dual challenge: containing or even reducing health expenditure while at the same time dealing with greater demand for its services. To date, these efforts have managed to be successful - regional deficits are now largely under control and the benefit package continues to be delivered effectively, albeit with much more tightly stretched resources and increased cost-sharing for some services. Italy’s belt-tightening responses to its fiscal crisis have also exacerbated the existing inequity across regions, where gaps in service provision and health system performance persist. 

Government policies have focused on setting caps on pharmaceutical spending, reducing the number of hospital beds and shifting care away from acute stays, increasing co-payments and instituting new purchasing contracts for medical goods. A major policy tool has been the adoption of ‘financial recovery plans’ by high-deficit regional health systems, targeting the structural determinants of costs, as well as national ‘health pacts’ binding regions to budgetary discipline. However, the overt focus on financial retrenchment should not overshadow the need for longer term strategies for better health system performance, such as efforts to promote greater group practice among health professionals working in primary care, bolstering the quality of professionals managing public facilities, and ensuring that the concentration of organizational control by regions of health care providers does not stifle innovation. 

The HiT report on Italy will be formally launched, in conjunction with the new OASI (Observatory on Italian Healthcare Management) report on the Italian National Health Service, at a conference, called "The National Health Service that we would like to have”, which will be taking place at Bocconi University (Milan) on 24 November 2014.