La governance dei sistemi sanitari tra bisogni locali e sfide globali

[Autom. eng. transl.] The health systems of the member states of the European Union are very different in many respects: from the relative role of the public and private in financing insurance schemes, to the organization of the provision of services, to the management of hospital medicine compared to territorial medicine. The differences reflect decisions established by national laws of the central government of the individual countries, which also reflect cultural settings on the role of the welfare state in a broader sense. In all countries, most of the functions relating to health systems are shared between different levels of government. For example, in Italy, the structure of supply is influenced by national legislation (which sets standards for beds per inhabitant and the structural characteristics of hospitals) and by regional legislation (which determines the organizational structure of the network of services within the region in the spaces of autonomy left by the national law). These examples show the difficulties of defining the degree of autonomy over the different functions. Similar considerations apply to functions shared between countries and the European Union such as the authorization to market drugs. The exercises of classifying health systems make clear the difficulties of standardizing functions and identifying common structures. In normative terms, the allocation of functions to different levels of government should be based on consideration of economies of scale, potential spillovers and heterogeneous preferences at the local level.