Italy: health system review

Italy is the sixth largest country in Europe and has the second highest\r\naverage life expectancy, reaching 79.4 years for men and 84.5 years for\r\nwomen in 2011. There are marked regional differences for both men and\r\nwomen in most health indicators, reflecting the economic and social imbalance\r\nbetween the north and south of the country. The main diseases affecting the\r\npopulation are circulatory diseases, malignant tumours and respiratory diseases.\r\nItaly’s health-care system is a regionally based national health service that\r\nprovides universal coverage largely free of charge at the point of delivery.\r\nThe main source of financing is national and regional taxes, supplemented\r\nby co-payments for pharmaceuticals and outpatient care. In 2012, total health\r\nexpenditure accounted for 9.2% of GDP (slightly below the EU average of 9.6%).\r\nPublic sources made up 78.2% of total health-care spending. While the central\r\ngovernment provides a stewardship role, setting the fundamental principles and\r\ngoals of the health system and determining the core benefit package of health\r\nservices available to all citizens, the regions are responsible for organizing\r\nand delivering primary, secondary and tertiary health-care services as well as\r\npreventive and health promotion services.\r\nFaced with the current economic constraints of having to contain or even\r\nreduce health expenditure, the largest challenge facing the health system is to\r\nachieve budgetary goals without reducing the provision of health services to\r\npatients. This is related to the other key challenge of ensuring equity across\r\nregions, where gaps in service provision and health system performance persist.\r\nOther issues include ensuring the quality of professionals managing facilities,\r\npromoting group practice and other integrated care organizational models in\r\nprimary care, and ensuring that the concentration of organizational control by\r\nregions of health-care providers does not stifle innovation.\r\n\r\nExecutive summary\r\nExecutive