Governance variables and equity in italian health care system. Some critical considerations


The institutional system of federalist type that is developing in Italy makes the study of the impact of health systems on health particularly relevant. The National Health Service has been characterized by a large and deep process of decentralization with transfer of responsibilities from the central to regional level, giving rise to – in fact – a plurality of regional health systems (Jommi, Cantù, and Anessi Pessina,  2001, Formez 2007; ASR 2007). In this process of decentralization of health governance, regional health systems that have emerged have specific characteristics in terms of health needs and hence the demand for health care, both at the organizational level of care offering health benefits, with different results in the context of health outcomes produced. Although the scientific community has largely accepted the fact that health inequalities are largely external to the healthcare system (Perucci 2004; Costa et al. 2004; Bunker et al 1994), the differentiation in the organization of health that is being achieved in Italian regions suggests it should to be kept under control, since it may be a harbinger of forms of production and reproduction of health inequalities alternatives to the traditional cleavage of social stratification (Lucchini et al. 2009). Equity in access to health care is one of the fundamental principles of the Italian health system: it is expressed in the right of all citizens with the same levels of need to access necessary health care. […]

Key-Words: Aziende sanitarie