Italy’s health care system and the crisis: overview of policy actions and their implementation = O sistema de saúde italiano e a crise: uma visão geral das políticas e sua implementação

Economic and fiscal crisis and political instability has put the Italian health system under strain during the 2010-2014 period that saw accelerated ongoing political changes. Government interventions in the Italian NHS have taken the form of either urgent decrees or measures in the annual state budget law rather than systematic reforms and have mostly consisted in caps on specific spending areas [1]. At the same time, higher co-payments for outpatient care and drugs have been introduced, adding to private spending on health. On the other hand, the 2015-2017 policy period provided more room for designing and developing long-term policy reform tackling macro-system aspects (appropriateness and quality of hospital care or national chronic care plan). However, performance in terms of health protection and quality of care has showed large variation across regions, mainly (but not exclusively) between the northern and southern regions. The worsening economic conditions had a negative effect on access to health care services for the most vulnerable groups of the population and the short-term effect on health showed an increase in psychiatric disorders and quality of nutrition, posing major challenges in the long run. The political challenge ahead is the reconfiguration of powers between the national and regional governments, where more wealthy regions are calling for greater (full) fiscal decentralization.