Conducting research in Italy? Just Worldwide Italy's Ian Becattelli and Ornella Gentile share useful information about how the Italian healthcare system works.
1. A public, tax funded system.
The Servizio Sanitario Nazionale (SSN), a public, tax-funded healthcare system, was established in 1978 based on the three core principles of universality, solidarity and uniformity.
2. Good health outcomes, despite underinvestment.
Despite covid and despite years of lower than EU-average funding, health outcomes remain good with life expectancy higher than the EU average (82.4 years vs 80.6 years) and preventable mortality lower than the EU average (104 deaths per 100k pop vs 160:100k). However, national averages hide wide regional variability in the quality of healthcare delivery.
3. The regions are in charge.
Italy’s 20 administrative regions have full autonomy over healthcare spending with large differences in philosophies and approaches. For example, in Veneto all hospital purchasing is centralised in an organisation known as Azienda Zero, whereas in other regions individual hospital trust do their own procurement.
4. Diagnosis related groups.
DRGs are used to allocate resources to hospitals. The system has undoubtedly increased efficiency and transparency.
However, an unwanted side effect is that it has created an incentive to a) discharge patients early and b) prioritise services which are reimbursed at higher tariffs over other services.
5. Recovery and resilience.
Massive investment has been approved through the EU-funded Recovery and Resilience Plan (PNRR) with €15.6 billion earmarked for spending on the SSN.
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