Chapter 2

3.1 - The efficiency of Regional Health
Systems
Allocation policies of financial resources
at regional level
Fioravanti L. 1 , Spandonaro F. 1
3.1.1 Introduction
The financial decisions of Regions tend to be associated with autonomy models (centralization/decentralization)
characterized by common features 2 . Even in the most decentralized
financial models, where resources are directly given to territorial health units, there
are several negotiation models between suppliers and purchasers (as well as the imposition
of destination and spending bonds) that lead back to a situation of (new)centralization.
Considering that regional decisions generally depend on social and economic situations,
perhaps the relationship between regional deficit and centralization level is strictly connected
to deficit and regional limits of destination and spending 3 .
3.1.2 Regional choices
The survey Regions (Calabria, Campania, Lazio, Piemonte, Sicilia, Sardegna and
Toscana) starting from financial resources assigned during the year 2005, in order to
analyze systems for allocation of resources to healthcare units.
Regions are presently independent in allocating healthcare funds (D.Lgs. 56/2000), but
they need to respect the Essential Level of Assistance (LEA) and find an efficiency objective.
The Regions indicated have generally adopted a system for the allocation of resources to
the healthcare units mainly based on the weighted per capita share. This is diversified
according to assistance levels 4 and following the criteria provided from the system of
national distribution. However shares of healthcare services are often allocated differentiated
financial resources compared to the objectives established by D.P.C.M. 24
November 2001, as confirmation of their autonomy.
For example, an indicator of regional autonomy is represented by resources assigned to
1 CEIS Sanità, Faculty of Economics, University of Rome “Tor Vergata”.
2 As indicated in CEIS Health Report 2004 and 2005, See Fioravanti L., Spandonaro F. (2004); Fioravanti L., Ratti M.,
Spandonaro F. (2005).
3 See Fioravanti L., Spandonaro F. (2004); Fioravanti L., Ratti M., Spandonaro F. (2005).
4 See Fioravanti L., Spandonaro F. (2004); Fioravanti L., Ratti M., Spandonaro F. (2005).
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CEIS Health Report 2006