Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-04-30T17:01:01.356Z Has data issue: false hasContentIssue false

How health care regionalisation in Italy is widening the North–South gap

Published online by Cambridge University Press:  10 February 2014

Federico Toth*
Affiliation:
Dipartimento di Scienze Politiche e Sociali, University of Bologna, Bologna, Italy
*
*Correspondence to: Federico Toth, Dipartimento di Scienze Politiche e Sociali, Strada Maggiore, 45, 40125 Bologna, Italy. Email: federico.toth@unibo.it

Abstract

The Italian National Health Service began experimenting with a significant regionalisation process during the 1990s. The purpose of this article is to assess the effects that this regionalisation process is having on the rift between the north and the south of the country. Has the gap between the health care systems of the northern and southern regions been increasing or decreasing during the 1999–2009 decade? Three indicators will be utilised to answer this question: (1) the level of satisfaction expressed by the citizens towards the regional hospital system; (2) the mobility of the patients among regions; (3) the health care deficit accumulated by the individual regions. On the basis of these three indicators, there is evidence to conclude that, during the decade under study, the gap between the North and the South, already significant, has increased further.

Type
Articles
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adolph, C., Greer, S. and Fonseca, E. M. (2012), ‘Allocation of authority in European health policy’, Social Science & Medicine, 75(9): 15951603.Google Scholar
Alesina, A. and Spolaore, E. (2003), The Size of Nations, Cambridge: MIT Press.Google Scholar
Costa-i-Font, J. and Greer, S. (eds) (2012), Federalism and Decentralization in European Health and Social Care, Basingstoke: Palgrave Macmillan.Google Scholar
Cotta, M. and Verzichelli, L. (2007), Political Institutions in Italy, Oxford: Oxford University Press.Google Scholar
DeVries, M. (2000), ‘The rise and fall of decentralization: a comparative analysis of arguments and practices in European countries’, European Journal of Political Research, 38(2): 193224.CrossRefGoogle Scholar
Ferrario, C. and Zanardi, A. (2011), ‘Fiscal decentralization in the Italian NHS: What happens to interregional redistribution?’, Health Policy, 100(1): 7180.Google Scholar
Fiorentini, G., Lippi Bruni, M. and Ugolini, C. (2008), ‘Health Systems and Health Reforms in Europe: the Case of Italy’, Intereconomics-Review of European Economic Policy, 43(4): 205212.Google Scholar
France, G. (1997), ‘Cross-border flows of Italian patients within the European Union. An international trade approach’, European Journal of Public Health, 7(3): 1825.CrossRefGoogle Scholar
Glinos, I., Baeten, R., Helble, M. and Maarse, H. (2010), ‘A typology of cross-border patient mobility’, Health & Place, 16(6): 11451155.CrossRefGoogle ScholarPubMed
Helderman, J. K., Bevan, G. and France, G. (2012), ‘The rise of the regulatory state in health care: a comparative analysis of the Netherlands, England and Italy’, Health Economics, Policy and Law, 7(1): 103124.CrossRefGoogle Scholar
Istat (2000), La vita quotidiana nel 1999, Rome: Istituto Nazionale di Statistica.Google Scholar
Istat (2010), La vita quotidiana nel 2009, Rome: Istituto Nazionale di Statistica.Google Scholar
Istat (2012), Noi Italia, Rome: Istituto Nazionale di Statistica.Google Scholar
Lavis, J. N. and Anderson, G. M. (1996), ‘Appropriateness in health care delivery: definitions, measurement and policy implications’, CMAJ, 154(3): 321328.Google Scholar
Levaggi, R. and Smith, P. (2005), ‘Decentralization in Health Care: Lessons from Public Economics’, in P. Smith, L. Ginnelly and M. Sculpher (eds) Health Policy and Economics: Opportunities and Challenges, Maidenhead: Open University Press, 223247.Google Scholar
Mapelli, V. (2012), Il sistema sanitario italiano, Bologna: il Mulino.Google Scholar
Messina, G., Vigiani, N., Lispi, L. and Nante, N. (2008), ‘Patient migration among the Italian regions in 2003’, Italian Journal of Public Health, 5(1): 4552.Google Scholar
Mills, A. (1994), ‘Decentralization and accountability in the health care sector from an international perspective: What are the choices?’, Public Administration and Development, 14(3): 281292.Google Scholar
Ministero dell’Economia e delle Finanze (2012), Relazione Generale sulla Situazione Economica del Paese – 2011, Rome: Ministero dell’Economia e delle Finanze.Google Scholar
Ministero della Salute (2010), Rapporto annuale sull’attività di ricovero ospedaliero, Dati SDO 2009, Rome: Ministero della Salute.Google Scholar
Ministero della Salute (2011), Relazione sullo stato sanitario del paese 2009–2010, Rome: Ministero della Salute.Google Scholar
Mosca, I. (2006), ‘Is decentralisation the real solution? A three country study’, Health Policy, 77(1): 113120.CrossRefGoogle ScholarPubMed
Oates, W. E. (1972), Fiscal Federalism, New York: Harcourt Brace Jovanovich.Google Scholar
Oates, W. E. (1999), ‘An essay on fiscal federalism’, Journal of Economic Literature, 37(3): 11201149.Google Scholar
Pavolini, E. and Vicarelli, G. (2012), ‘Is decentralization good for your health? Transformations in the Italian NHS’, Current Sociology, 60(4): 472488.Google Scholar
Peckham, S., Exworthy, M., Powell, M. and Greener, I. (2008), ‘Decentralizing health services in the UK: a new conceptual framework’, Public Administration, 86(2): 559580.Google Scholar
Pica, F. and Villani, S. (2010), ‘Issues regarding the standard cost notion: patients’ interregional mobility and health fashions’, MRPA Paper n 29659, http://mpra.ub.uni-muenchen.de/29659Google Scholar
Prud’homme, R. (1995), ‘The dangers of decentralization’, The World Bank Research Observer, 10(2): 201220.Google Scholar
Putnam, R. D. (1993), Making Democracy Work: Civic Traditions in Modern Italy, Princeton: Princeton University Press.Google Scholar
Rondinelli, D. A., Nellis, J. R. and Cheema, G. S. (1983), Decentralization in developing countries, Washington, DC: The World Bank.Google Scholar
Saltman, R. and Bankauskaite, V. (2006), ‘Conceptualizing decentralization in European health systems: a functional perspective’, Health Economics, Policy and Law, 1(2): 127147.Google Scholar
Saltman, R., Bankauskaite, V. and Vrangbaek, K. (eds) (2007), Decentralization in Health Care. Strategies and Outcomes, London: Open University Press.Google Scholar
Tediosi, F., Gabriele, S. and Longo, F. (2009), ‘Governing decentralization in health care under tough budget constraint: What can we learn from the Italian experience?’, Health Policy, 90(2): 303312.Google Scholar
Tiebout, C. (1956), ‘A pure theory of local expenditure’, Journal of Political Economy, 64(5): 416424.CrossRefGoogle Scholar
Treisman, D. (2007), The Architecture of Government, Rethinking Political Decentralization, Cambridge: Cambridge University Press.Google Scholar