The evolution of the national health service in the dynamics maintained between the italian state and the regional administrations

Abstract

The regionalist structure of the Italian National Health Service began to take shape in the 90 and is strongly linked to demands that respond mainly to the principles of efficiency and control of public expenditure. This trend was reinforced by the constitutional reform of 2001. The subject that is now attributed to shared competence is “health protection”, with a greater scope than the previous one, which was limited only to health and hospital care. This has led to a strengthened regionalization of the health system. As partial compensation, the state authorities have retained a strong governance power in the area of controlling public expenditure, especially in the case of regional deficit management, through the activation of the so-called ‘patti di rientro’ (repayment pacts). Despite this prevailing trend, the Constitutional Court’s interpretation of the distribution of competences left different spaces for State intervention, which must guarantee the equality of citizens. Since the need to control public spending has been the dominant pattern, the central government has been mainly concerned with setting the parameters of equilibrium, especially in terms of efficiency. This has weakened the focus of the public service culture and the equity of care. In order to ensure equality within a framework of sustainable differentiation of organizations, essential levels have been identified, which are the exclusive responsibility of the State, but experience shows that the rebalancing force of essential levels has been overestimated.