Focus Paper no. 9 / 21 December 2015

Download PDFReviewing public spending: the healthcare system


The Stability Bill appropriates €111.0 billion for Italy’s National Health Service (NHS) in 2016, slightly higher than the €109.7 billion appropriated for 2015 but less than the amount that would have been available on a current legislation basis under last year’s budget (€113.1 billion). The bill also established additional cuts for 2017-2019 as a result of the increase in the regions’ contribution to readjustment of the public finances. At the same time, however, the measure specifies that “compliance with essential care standards” shall not be jeopardised by the reductions. The actual compatibility of the reduction in appropriations and the sustainability of the NHS remains to be demonstrated.


The Focus offers an examination of the complex relationship between resources, the efficiency/effectiveness of the use of those resources and the quality of and access to health services. The question of whether the spending review measures could jeopardise the system’s mission of safeguarding health has no complete or definitive answer. On the one hand, the regions can still improve the cost effectiveness of services through measures to contain waste, improve organisational efficiency, separate public and private interests more sharply and increase the appropriateness of services, although the scope for action is narrowing. On the other hand, certain signs are emerging of limitations on physical access (rationing) and economic access (co-payments) to services and shortcomings in the organisation and delivery of services, tied to shortfalls of financial and human resources, which could worsen even further.


Text of document (in Italian)