
Contents
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I. Introduction I. Introduction
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II. The Italian Health System II. The Italian Health System
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Historical Overview Historical Overview
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Development of Public Health Services and the Hospital System Development of Public Health Services and the Hospital System
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Medical Licensing and the Medical Profession Medical Licensing and the Medical Profession
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Introduction of Public and Private Health Insurance Introduction of Public and Private Health Insurance
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Main Reform Developments of Postwar Period Main Reform Developments of Postwar Period
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III. Description of the Current Health System III. Description of the Current Health System
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Coverage Coverage
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Access for Migrants Access for Migrants
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Financing Financing
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Administration Administration
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Provision and Payment of Services Provision and Payment of Services
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Hospital Care Hospital Care
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Outpatient Care Outpatient Care
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Nursing and Long-Term Care Nursing and Long-Term Care
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Gatekeeping and Cost Containment Gatekeeping and Cost Containment
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Improving the Quality of Care, Medical Outcomes, and Prevention Improving the Quality of Care, Medical Outcomes, and Prevention
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Patient Rights Patient Rights
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Public Perceptions of the Health System Public Perceptions of the Health System
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IV. Politics of Health Reform Since 1989 IV. Politics of Health Reform Since 1989
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Overview Overview
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1992–1993 Reform of the Reform 1992–1993 Reform of the Reform
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1999 Third Reform 1999 Third Reform
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Fiscal Federalism Measures Fiscal Federalism Measures
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2001 Constitutional Reform 2001 Constitutional Reform
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State–Regions Agreements, Health Pacts, and Recovery Plans State–Regions Agreements, Health Pacts, and Recovery Plans
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2001 State–Regions Agreement 2001 State–Regions Agreement
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2005 State–Regions Understanding and Recovery Plans 2005 State–Regions Understanding and Recovery Plans
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Setting and Updating “Essential Levels of Care (LEAs)” Setting and Updating “Essential Levels of Care (LEAs)”
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New Rules on Integrated Health Funds New Rules on Integrated Health Funds
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2008 Crisis and Austerity Measures 2008 Crisis and Austerity Measures
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2012 Balduzzi Reform 2012 Balduzzi Reform
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2017 Urgent Provisions on Vaccines 2017 Urgent Provisions on Vaccines
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V. Conclusion V. Conclusion
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References References
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Cite
Abstract
This chapter offers an in-depth look at health politics and the decentralized, tax-financed health system in Italy. It traces the development of the Italian healthcare system, including the processes leading to hospital reform and regionalization in the 1960s and 1970s and the creation of the national health service in 1978. Since the late 1980s, health policy has been shaped by the transformation of the Italian political system, further transfer of powers to the regions, and public expenditure constraints due to public debt. Policies inspired by the New Public Management approach that aimed to increase the health system’s cost-effectiveness through steps towards fiscal federalism were introduced and reversed. Over the course of the 2000s, agreements between the central state and regional governments have become the main tool for coordinating health policy and trying to settle recurring disputes regarding health expenditure responsibilities. Ongoing debates on healthcare concern measures to ensure the national health service’s sustainability, typically the control and containment of its costs, and to reduce the territorial gap and other gaps that clash with the system’s universalist design.
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