The Italian National Health Service after the Economic Crisis: From Decentralization to Differentiated Federalism

Neri, Stefano

doi:10.4000/eces.4403

Cited by 7 publications

(9 citation statements)

References 21 publications

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“…One of the main repercussions of the funding cuts was the decrease in the number of employees in publicly funded hospitals. 7 The number of permanent staff fell by 7% and nonpermanent staff declined by 37.8%. 22 In addition, 116 public hospitals were closed, leading to a reduction in public hospital beds from 4.1 to 2.5 for every 1,000 inhabitants.…”

Section: Discussionmentioning

confidence: 98%

“…Although the Italian NHS is public, the funding and the provision of health goods and services are mixed, based on a combination of public and private providers that varies across all regions. 7 In all Southern regions, for instance, the proportion of public funding for health systems is higher than in the North of Italy, where the proportion from private funding is higher. 8 When seeking health care, citizens choose among public, private, and accredited private hospitals.…”

Section: Box 1 the Provision Of Health Goods And Services In The Italian Nhsmentioning

confidence: 99%

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The Privatization of the Italian National Health System and its Impact on Health Emergency Preparedness and Response: The COVID-19 Case

Buzelli

Boyce

2021

Int J Health Serv

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Hospitals play a critical role in providing essential care during emergencies; however, this essential care can overwhelm the functional capacity of health systems. In Italy, substantial cuts in funding have drastically reduced the resources of the National Health Service (NHS) and contributed to the expansion of the private health sector which, unlike the public health system, does not have the capacity to deal with a health emergency such as coronavirus disease 2019 (COVID-19). The purpose of this article is to show how the privatization of the NHS contributed to making Italy more vulnerable and unprepared to tackle the COVID-19 pandemic. The available capacity and resources in the public and private emergency services systems in Italy are compared, including a focus on the numbers of hospital staff, hospitals, and hospital beds. The reduced funding and subsequent shortfalls in services in the NHS are reasons why extreme measures were needed to increase these resources during the COVID-19 pandemic. A public NHS in Italy would be better prepared for future health emergencies. The lessons learned from the COVID-19 pandemic can help to inform future health systems strategies, to halt the current financial decline and performance loss of national health systems, and to enable better preparation for future health emergencies.

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Section: Discussionmentioning

confidence: 98%

Section: Box 1 the Provision Of Health Goods And Services In The Italian Nhsmentioning

confidence: 99%

The Privatization of the Italian National Health System and its Impact on Health Emergency Preparedness and Response: The COVID-19 Case

Buzelli

Boyce

2021

Int J Health Serv

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“…Austerity policies intensified earlier trends to transform the NHS into a more 'hybrid' system, characterised by public retrenchment and the growing role of privatisation and corporatisation in health-care financing. Occupational and corporate health funds rose from a minor share to more than one-third of total employees in the past decade (Ascoli et al, 2018;Neri, 2019a). The spread of health occupational funds, fostered by fiscal incentives, was accepted by the unions, which saw it as compensation for the lack of or restrictions on wage increases in an era of economic crisis (Pavolini et al, 2018).…”

Section: Austerity Policies and Employment Relations In Health And Social Care In The Wake Of The Economic Crisismentioning

confidence: 99%

“…Since 2007, all nine southern and centralsouthern regions (excluding the small region of Basilicata) have been involved in a recovery plan, compared to only two out of the 11 northern and central-northern regions. As regions subject to and those not subject to the recovery plans have very different levels of autonomy in health policy, the implementation of this mechanism has de facto introduced a sort of 'differentiated health-care federalism' between Italy's north and south (Frisina Doetter and Neri, 2018;Neri, 2019aNeri, , 2019b.…”

Section: Austerity Policies and Employment Relations In Health And Social Care In The Wake Of The Economic Crisismentioning

confidence: 99%

‘Intended’ and ‘unintended’ consequences of the privatisation of health and social care systems in Italy in light of the pandemic

Ciarini

Neri

2021

Transfer: European Review of Labour and Research

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This article analyses the long-term effects of privatisation and marketisation on the Italian regional health and social care systems. The research focuses on three Italian regions – Lombardy, Veneto and Lazio – which are representative of three different models of governance in these sectors. We examine the effects of privatisation and marketisation on the health and social care system by discussing how the regional health-care systems have managed the impact of the COVID-19 pandemic. We also shed light on the dramatic consequences of the pandemic crisis on employment levels and working conditions.

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“…So far, healthcare system 'hybridisation' [29] and the trend to 'differentiated federalism' [28] or 'differentiated autonomy' have occurred without any structural reforms, by means of imperceptible but progressive changes which, in terms of institutional change, may be qualified in terms of 'gradual transformation' [30,31]. However, the formal request for constitutional change by three regions and related, current political conflicts, as well as the increasing complaints and also protests by doctors and healthcare experts on NHS underfinancing, emphasised by the media, might help promote an open debate on the future of the Italian NHS and health policy, which has been completely lacking so far.…”

Section: Author Detailsmentioning

confidence: 99%

Economic Crisis, Decentralisation and Health Inequalities: The Case of Italy

Neri¹

2019

Universal Health Coverage [Working Title]

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The chapter describes the recent evolution of the Italian National Health Service (NHS), highlighting the potential and effective consequences of the economic and financial crisis on social and territorial inequalities, especially in terms of service access and quality. First, it analyses the cost-containment and austerity policies in the NHS, which brought to a relevant underfunding of the public healthcare system, comparing public expenditure trends in Italy with those of other Western European countries. Then, it stresses the increasing role played by private expenditure, emphasizing the risks in terms of health inequalities connected to the high level of out-of-pocket payments and to the spread of the occupational funds. Finally, a reconstruction and analysis of the current changes in the NHS governance is carried out, explaining in details how the reassertion of the role of the Central State in health policy entails different consequences for different areas of Italy, widening the territorial inequalities and increasing the North-South divide. So far, these changes have taken place without any structural reform, in an imperceptible but progressive way, which does not help to develop an appropriate and necessary debate on the future of the healthcare system. 2As a result, the NHS is structured on three levels: a national level, constituted mainly by the Ministry of Health; an intermediate level represented by the Regions and their Regional Ministers and health departments and a local operational level, directly accountable to the Regional one, made up of about 70-75 Aziende sanitarie ospedaliere (hospital trusts, henceforth HTs) and about 135-140 Aziende sanitarie locali (local health authorities, henceforth LHAs).Since 2001, no major reforms have been introduced into the NHS. However, important changes have almost imperceptibly taken place, connected the economic and financial crisis, which are weakening the universalist nature of the NHS.This chapter will analyse the evolution of the NHS in Italy during the last decade, hence in the years of the crisis, focusing on some trajectories of change underway, mainly in the health expenditure and in the NHS institutional framework governance. These trends might have important consequences in terms of service access and quality, increasing the traditional social and territorial inequalities and hence weakening the universalistic nature of the NHS.

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The Italian National Health Service after the Economic Crisis: From Decentralization to Differentiated Federalism

Cited by 7 publications

References 21 publications

The Privatization of the Italian National Health System and its Impact on Health Emergency Preparedness and Response: The COVID-19 Case

The Privatization of the Italian National Health System and its Impact on Health Emergency Preparedness and Response: The COVID-19 Case

‘Intended’ and ‘unintended’ consequences of the privatisation of health and social care systems in Italy in light of the pandemic

Economic Crisis, Decentralisation and Health Inequalities: The Case of Italy

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