MODELLI ORGANIZZATIVI SANITARI PUBBLICI E PRIVATI TRA INTEGRAZIONE, COMPLEMENTARIETÀ E OUT-OF-POCKET.

[Autom. eng. transl.] INTRODUCTION: For many of the societies, the realization of the well-being of the population is realized through programs that favor access to health care. Several studies have shown that country governments, while considering health care as a key responsibility, use different organizational models. Public and private health, within these models, can be integrated, overlapped or completely differentiated, generating extremes from organizational efficiency to disorganization, if not substantial confusion. The present study originates from the growing concern, in a period of economic crisis and "spending review", of active sustainability of the current universalistic and solidarity model of Italian Public Health and how it can evolve in the future. MATERIALS AND METHODS: The research was carried out, through a systematic review, consulting the scientific literature, national and international, concerning studies published on the public health branding available in the most important and main online databases, with free access. The main governance mechanisms present in the different health systems of European and non-European countries were analyzed in a comparative manner. RESULTS: From the analysis carried out, consulting 32 institutional sites in addition to media and Cochrane, deriving 239 articles and reports of which 24 responding to the inclusion criteria in the study, it is highlighted that the largest complementary health care market is in the Netherlands (used since 1989 % of the population), followed by Israel (80%). Australia and Ireland, which present a Public Health System, have duplicated the care offer market, providing through the private sector those services that would have long waiting times. Furthermore, some countries, such as France, Israel, Belgium, Canada and the United States, guarantee health services with private coverage for over half of the population. In Italy about 14.89% of the population, to date, has some form of private health insurance, generally to cover services excluded from the National Health System (SSN), or to benefit from a high standard of comfort and privacy in facilities hospitals or to have a wider choice of public and private providers. Finally, in many countries, such as Mexico, Portugal, Belgium, Australia and the United States, families support almost all health expenditure "on their own and autonomously". CONCLUSIONS: The study found that each country, with reference to the characteristics of its population, identifies its own health care system in order to satisfy the health needs of the resident and non resident population. This implies, however, the use of qualitative and quantitative indicators of welfare goodness, often not comparable, defining differentiated non-overlapping standards. Furthermore, this does not always highlight the "success" with respect to the planned objectives, where the indicators often express more the achievement of quantitative and qualitative results, which are more typical of the concept of expected welfare welfare. Consequently, those countries that are able, even with mixed health systems, to guarantee the same quality of care to all citizens in the short term are worthy of appreciation.