Italy

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.