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Introduction and Background

Italy, the largest country in Europe, is listed among the countries that provide the best quality health services by the World Health Organization. The Italian National Health Service referred to as Servicio Sanitario Nazionale was started in the year 1978 with human dignity, universal coverage, and solidarity as the golden rules. The health plan ensures that health services are affordable or free inclusive of hospital management visits, medication, lab work, and consultations. The health care system is divided into three levels that is the national, regional and local levels. The role of the national level is to ensure the fulfilment of the general objectives and fundamental principles of the Servizio Sanitario Nazionale. Regional governments via their regional health departments play the role of ensuring that all the 16 health systems in the country receive a package of benefits via a network of local health authorities and both private and public accredited hospitals.

Majority of the people living in the area have a high quality of life and standard of living as a result of standard welfare measures and policies. Although some healthcare facilities are considered useful in dealing with emergencies, some medical facilities are allegedly overcrowded and lack adequate funds (Mackenbach, Karanikolos and McKee 2013, pp.1125-1134).This essay seeks to explain the healthcare system of Italy using the World Health Organization healthcare systems framework. It also aims at evaluating the performance of the health system including both the past and current reforms using the available peer-reviewed articles.

Inclusion of examples

Italy's Organizational and structure is well organized and aims at providing universal health care coverage at the point of delivery. Italy's ministry of health is guided by fundamental principles as well as the objectives of the health system. Every region has the duty of providing health care services to the patients. This means that the regions differ regarding the level of healthcare provided. Although no law has specified patient rights and empowerment, they are present in the Italian constitution as well as some pieces of legislationatic strategy(Nuti, Vola, Bonini, and Vainieri 2016, pp.17-38).

Secondly, the health care system is mainly funded using both regional and national taxes and co-payments from outpatient and pharmaceutical care. The role of government as outlined in the Italian constitution is to decide the national statutory benefits package to be given to all the people is all the regions. It is the responsibility of the two independent provinces and 19 regions to plan and deliver health care services through the local health units. Majority of the regions lack sufficient funds to run their day to day activities. This has a negative influence on the health of the people often leading to increased mortality and morbidity rates. Increased economic crisis and corruption has led to the mismanagement of funds and hence disrupting services (De Belvis et al. 2012, pp.10-16).

Thirdly the healthcare system medical technologies and products have decreased over the years due to cost-cutting measure that is taking place in the country. Regarding the infrastructure in the hospital sector, in the year 2012, Italy had an estimated 3.4 hospitals per 1000 patients; 80% of which are set aside for patients in acute care. The number of CT scanners, MRI units, and PET units have increased, the government has also developed e-health initiatives. There is a great need of purchasing new medical products and technology that will help in the delivery of healthcare. Present development should be keen on expanding electronic health records and online services. As a result, there has been digitalization of medical certificates and prescriptions (Marchildon 2013).

Fourthly, although there has been an increase in the health workforce, with an estimated 3.7 practising doctors per 1000 patients, there is need to increase the workforce to meet the needs of the community. Regarding health worker mobility, Italy has a significant level of 72 health systems in transition Italy inflows for some categories of health professionals such as care assistants and nurses which is attributed to substantial nursing shortages. Doctors are the most affected by emigration. In the year 2010, SSN employed an overall 646 236 healthcare personnel. 18.1% were technical staff, 70.2% were health staff, and 11.7% were administrative staff. Among the employed health staff. 58.3% were nurses, 23.7% were physicians and the rest 18% were other health professionals (Marchildon 2013).

Fifthly, regarding service delivery, the ministry of health' responsibility is to ensure that public health services are delivered at the national level. Programs such as screening and immunization are prioritized. Also, pap tests, immunization programs, colorectal screening, and mammography are offered nationally to the target population at free of charge. However, there is a need to sensitize more people to utilise the services (Bordogna 2011, pp.411-423).Lastly, concerning information and research, the country has failed to increase the use of communication and information technologies in research to ensure that there is the provision of quality care.

Analysis of issues relevant to the healthcare system

Various health indicators have improved over the years; for instance, the country has a life expectancy of an estimated 79.4, 84.5 years for men and women respectively in the year 2013 indicating that it is the second highest in the world. Italy has a vast difference in funding of different regions with some regions having per capita expenditure of an estimated 17.7% above the national average and 10.2% below. Even though most funds are assembled at the national level and distributed to different regions, there is a scope for the significant regional disparity in tax rates. Concurrently, there has been the introduction of copayments for drugs, ambulatory and outpatient care and diagnostics (Vainieri and Nuti 2011).

The health system has succeeded in prevention strategies such as vaccination. There is also an improvement in the care for patients with chronic conditions. However, the prevalence of risk factors such as obesity and overweight has increased over the years. Despite the fact Italy has a federal structure, majority of the regions cannot fund healthcare using their resources (Nuti, Seghieri, and Vainieri 2013, pp.59-69).As a result, they rely on central transfers to recover for the differentiation in local incomes (Turati 2013, pp. 47-66).

Although the main country objective is to ensure equity in the access of health care, the country suffers severe inequalities in the provision of healthcare across people with different socioeconomic status.Some of these inequalities arise from the difference in population wealth and efficiency of healthcare mainly in the southern and northern regions in Italy. In the recent years, there has been a decline in the level of satisfaction of consumers (Pavolini and Vicarelli 2012, pp.472-488).

There is no increased use and access of information and technology among the healthcare providers. There is need to improve both technology and information, for instance, the healthcare professionals in Italy need to access online medical resources to enhance their knowledge about specific diseases and new methods of treating the disease as wells the use of new medical equipment. The healthcare professionals need to use the available medical information to ensure that they meet the patients' needs and that they receive the right care (Anon 2017).

Future challenges and emerging issues that may affect Italy’s healthcare system include technic, ethical and economic factors. The health system is likely to face increasing financial constraints and hence affecting the delivery of services (Karanikolos et al. 2013, pp.1323-1331).The country is also expected to experience a situation where patients wait for an extended period to receive services such as outpatient and diagnostic services. This is due to the inequitable distribution of local health facilities among different socioeconomic groups, regions, and gender.

Lessons learned from other countries in the European region is that it is essential to increase human resources for health and restructure the delivery of healthcare services. It is also essential to ensure that there are reduced corruption cases in the healthcare system. Another lesson learnt is that the majority of the funds should not be spent on the healthcare providers, instead, they should be channelled to the delivery of healthcare.

Relevant data and literature

Italy’s healthcare system has undergone numerous reforms. The establishment of the second reform of SSN took place in the year 1978 in place of a system that relied on much social health Insurance. This was the first significant health care reform to occur in Italy during the post-second world war period. Although the SSN system was implemented entirely in the 1980s, the weaknesses of the system became evident in the same year (Marchildon 2013). Firstly, there was a lack of expertise to ensure the proper functioning of the Healthcare system. Secondly, the central government was unable to exercise control over the finances. Thirdly, there was an endless politicization of the SSN institutions. Finally, there was a lack of proper management systems (Coulter and Jenkinson 2015, pp.355-360).

Italy was hit by a high debt and economic crisis hindering the country from meeting the Maastricht criteria on recommended European monetary union. Also, several corruption scandals led to the collapse of Italy’s central governing parties. However, a new government was formed and managed to decrease public expenditures in many sectors such as the healthcare sector. In this moment of opportunity, the SSN second reform was quickly approved. The reform incorporated regionalization, managerialism, quasi-market for specialist care and opting-out of the National Health Service(Francese and Romanelli 2014, pp.117-132).

The third health-care reform was put into law in the year 1999. The reform emphasized the SSN health system was universal and other the control of the government. In the year 2001, a constitutional reform was invented and comprised the overall provision of fiscal federalism. It also included setting the principle that sub-national levels of government including regions, municipalities, and provinces should only utilize the money they collect from their respective constituencies and to some extent have access to resources that show their respective constituencies’ contribution to the national taxes through corporate, personal and other taxes. Therefore this critical reform includes a wholesale redesign of the fiscal system of Italy and hence making it more dependent and decentralized on regional contexts. It also includes the proper distribution of resources across the regions to ensure that all citizens receive essential services (Marchildon 2013). Since all the regions must deliver and organise health care services, putting the reform into law will have a positive impact on the allocation of human resources management and the funding available to the local health systems (Costa-Font and Greer 2016).

A huge step in the adoption of a framework law for Fiscal federalism was taken in 2009. The framework explained the processes to make sure that there is proper coordination between the different levels of the government. It also outlined the principles to be used in the redistribution of resources to the standards of government with the lowest own revenues. The essential element for the proper funding of the health care services is to ensure equalization fund through which regions with the lowest revenue collection are targeted to ensure that they receive quality health care (Lynch 2014, pp.380-388).

Both the New resource allocation framework, as well as the Equalization fund, have not been put into use. While nine enforcing decrees were put into law by the parliament, a special parliamentary in the year 2013 established that the reform was not complete. Many critical aspects had been deferred while others had not been tackled. Majority of political factors are responsible for this; firstly, there has been political instability due to three changes of government from 2013. Secondly, contemporaneous reforms that collide with the idea of the fiscal federalism framework such as eliminating provinces have prevented its implementation. The implementation of the framework relies on the future political situation (Petmesidou, Pavolini and Guillén 2014, pp.331-352).

In 2012 there were efforts to initiate the most comprehensive reform of Italy’s healthcare system referred to as Balduzzi decree. In 2001, the original benefits package was seriously revised for the first time inclusive of services such as epidurals during childbirth and the treatment of about 110 rare diseases. Also, doctors were encouraged to perform their activities within the SSN healthcare facilities. A decision also arrived at that primary care should be restructured into groups of professionals to ensure they give 24-hour coverage. Stronger regulations were also made on minors engaging in alcohol and smoking activities. Furthermore, there was the introduction of policies to reduce pharmaceutical costs. Although the parliament passed the Balduzzi reform in 2013, it has not been implemented due to political instability (Marchildon 2013).

Amid increasing political instability, there have been central cost containment policies. On the one hand, they help in ensuring control over the overall expenditure and ensuring that regions do not overspend. On the other, they target the sources of regional expenditure with the use of measures on recruitment, payment of health personnel and standards of hospital care. For instance, currently, there is a policy aiming at reducing the pharmaceutical expenditure using measures such as reexamining the percentage of the overall cost concerning pharmaceutical companies, pharmacies, and wholesalers (Blendon, Leitman, Morrison and Donelan 2011 pp.185-192).

Other measures include continuous cutback of the cap on local pharmaceutical spending in community and primary health care as well as decreasing the price of particular drugs Satisfaction with health systems in ten nations.Another example is the cutting down of costs in purchasing medical equipment. This measure was strengthened in 2012 with an aim on ensuring that all the SSN contracts are acquired using standard prices. In addition, the government has encouraged regions to cut on their expenditure on health professionals (Levaggi and Menoncin 2013, pp.725-737).


Italy's healthcare system has made enormous progress in delivering quality health care to all people irrespective of the social class and gender. However, much can be done to address all the challenges the healthcare system is facing. For instance, the country can ensure that there is an improvement in the efficiency of local health facilities as well as increased prevention of diseases.


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