Chapter 2

CEIS Health Report 2006
ciated with the growth of health expenditure. First, the greatest part of health expenditure
is still publicly financed, especially in EU member countries. In Italy, public resources
for financing of health care account for 76,0% of total expenditure, a figure higher
than the OECD mean. The growth of health expenditure naturally increases the anxiety
of policy makers who have to deal with ever tighter public budgets. Second, and still
more important, most of the resources employed in health care are not at an optimum
level of quality or efficiency 22 . In fact there is ever increasing evidence of deficiencies –
such as those associated with provision of inadequate services or suboptimal utilisation
of services of proven necessity, or again those associated with errors in the provision of
health care – which lead to unexpected deaths, excessively high differences in mortality
within the same country 23 , disablement and a low standard of health, often with a marked
increase in costs.
It therefore seems necessary to focus attention on greater efficiency in health expenditure
24 – on which the efforts of those responsible for health policy should be concentrated
– rather than a mere sterile containment of the growth of health expenditure which
could led to an undesirable difference between the expectations of the population and
the capacity of health systems to provide care. Again, associated with what has been
said, measuring, analysing and monitoring the real efficacy of the health system one
could certainly reduce the lack of transparency regarding the quality of and outputs supplied
by the health systems. Inter-country comparative analysis can help on two fronts,
by providing a benchmark for an improved evaluation of the performance of national
health systems, and at the same time a set of measuring instruments that individual
countries can implement and use in order to raise the efficiency of their own health
systems (see, for example, the DRGs, policies on access to new drugs, equity in distribution
etc.).
A need is thus felt to create the preconditions for promoting optimum allocation of
resources, increasing the satisfaction of the public and avoiding the duplication of services
and possible inequities. The debate about the way health services in Italy and in
EU countries are organised is therefore still at the centre of attention, but seemingly
without one model prevailing over others.
In fact new modalities for organising and managing health care systems are still being
introduced, often with see-saw results. At times one manages to obtain an increase in
efficiency, while at others times the objective attained is not clear 25 .
References
● Atella V, Donia Sofio A, Mennini FS, Spandonaro F (edited by) 2003., “Rapporto CEIS Sanità
2003. Bisogni, risorse e nuove strategie”, Italpromo Esis Publishing.
● Atella V, Donia Sofio A, Mennini FS, Spandonaro F (edited by) 2004, “Rapporto CEIS Sanità
22 See OECD (2004b); Oliver et al. (2005).
23 See Palazzo F et al. (2006).
24 See OECD (2004b); Oliver et al. (2005); Maynard A (2005).
25 See Maynard A (2005).
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