Healthcare Reform and Disease Management in Italy: Promoting the Effectiveness and Appropriateness of Health Service Use
The 1999 reform of the Italian healthcare system has softened the effects of the 1992 shift to market mechanisms and competition within healthcare by promoting cooperation and partnerships among providers and Local Health Units (LHUs). In addition, it has facilitated the completion of transfering organizational and financial responsibility to the regional governments. Such health policy developments require both the introduction of administrative tools, which stimulates integration, and the design of a coherent policy for quality of care. A 3-fold integration between healthcare and social services has been promoted to tackle the introduction of administrative tools: institutional integration between municipalities and LHUs, managerial integration at the district level for the provision of primary care and non-hospital care, and professional integration between healthcare professionals. A similar approach has characterized the policy for quality of care: an essential benefit package is to be identified as a guarantee to all citizens, practice guidelines will be developed and implemented and an accreditation process is underway. Implementation issues aside, effective introduction of the suggested tools requires careful planning and organization of the system and, above all, coordinated interventions at the 3 levels of healthcare provision (i.e. the macro, intermediary and micro levels).
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