Chapter 2

Management of the Italian
National Health System:
Complexity and Perspectives of the New Institutional Set Up
Spandonaro F. 1
1 Introduction
Year 2007 is going to begin under the auspices of a new agreement between Government
and Regions, the so-called “Pact for Health”. In the decision of the institutional authorities
to set a “new deal”, we seem to see both the need and the will to control the evolutions
of the health system, that is to put the SSN (Italian NHS - National Health Service)
at the service of the objectives for which it was created: namely protection from health
related risks.
For the fourth year running, the CEIS Report offers both points for reflection and proposals
from the point of view of aware and effective management of the Health System.
The contributions in the volume are the fruit of research in different areas, brought together
on the basis of the support they can provide for the decision-making process; they
are linked by a logical thread which this year is the complexity involved in controlling the
system.
This introductory chapter examines, though not exhaustively, the reasons for that complexity
and possible responses by the policy makers; it provides a key to reading of the
volume.
2 The context
The introductory reflection is on the importance of the financial argument in the health related
policies debate. Year after year, agreement on financial questions becomes the necessary
condition for signature of any institutional agreements, like the new “Pact for Health”.
The importance given to the financial aspect is well summarized by the alarm sounded
on health costs, often accused of being out of control. However, analysis of the available
data does not seem to provide complete support for that claim.
According to the latest OECD Health Data, used for reasons of comparability, health
expenditure in Italy in 2004 amounted to 8,4% of GDP, well below the 9,5% average of
the 22 countries examined (see chapter 1.1, Francia, Mennini).
One also finds that the growth of health expenditure, though faster than that of GDP in
all countries, has been relatively modest in Italy, making our country one of the most “virtuous”.
The increase by 0,7 percentage points of GDP from 1990 to 2004, though sub-
1 CEIS Sanità, Faculty of Economics, University of Rome “Tor Vergata”.
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CEIS Health Report 2006