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Lessons from the Italian NHS retrenchment policy

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  • Longo, Francesco

Abstract

In policymaking, implementation is often more critical than design. A variety of policy implementation frameworks can be used to explain implementation gaps and shifts. Each research stream suggests some solutions to prevent shortfalls. We have assessed two of these implementation strategies in the recent INHS (Italian National Health Service) retrenchment policies: (1) centralizing to rapidly cut expenditures, (2) effective management as an output- and not input-based system. The implementation of the INHS retrenchment policy has been very difficult though effective in a short period of time. A multi-level governance structure was put in place that assigned different but clear roles, powers and responsibilities to central and regional governments and public health care organizations. The entire policy was based on an exclusive input-based approach to introduce opacity in the system's prioritization processes. We most likely need to reconsider the identification of crucial implementation drivers in the public realm.

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  • Longo, Francesco, 2016. "Lessons from the Italian NHS retrenchment policy," Health Policy, Elsevier, vol. 120(3), pages 306-315.
    • Handle: RePEc:eee:hepoli:v:120:y:2016:i:3:p:306-315
    DOI: 10.1016/j.healthpol.2016.02.001
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    Cited by:

    1. Mauro, Marianna & Giancotti, Monica, 2023. "The 2022 primary care reform in Italy: Improving continuity and reducing regional disparities?," Health Policy, Elsevier, vol. 135(C).
    2. Signorelli, C. & Odone, A. & Oradini-Alacreu, A. & Pelissero, G., 2020. "Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary," Health Policy, Elsevier, vol. 124(1), pages 69-74.
    3. Claudio Costa & Maria Grazia Franco & Patrizia Bonesso & Simone De Bellonia & Domenico Mantoan, 2020. "Analisi e valutazione del fabbisogno di personale nelle aziende sanitarie attraverso l?utilizzo di strumenti di Business Intelligence - L?esperienza della Regione del Veneto," MECOSAN, FrancoAngeli Editore, vol. 2020(114), pages 107-133.
    4. Cavazza, Marianna & Vecchio, Mario Del & Fattore, Giovanni & Fenech, Lorenzo, 2023. "Geographical variation in the use of private health insurance in a predominantly publicly-funded system," Health Policy, Elsevier, vol. 130(C).
    5. Elio Borgonovi & Alessandro Furnari & Alberto Ricci, 2020. "La neuro-riabilitazione ospedaliera di alta complessit? per pazienti con gravi cerebrolesioni vascolari: quali potenziali impatti sulla spesa pubblica?," MECOSAN, FrancoAngeli Editore, vol. 2020(114), pages 89-105.
    6. Yuxi Wang & Simone Ghislandi & Aleksandra Torbica, 2020. "Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(8), pages 1149-1168, November.
    7. Cinelli, Gianmario & Fattore, Giovanni, 2024. "The 2022 community-based integrated care reform in Italy: From desiderata to implementation," Health Policy, Elsevier, vol. 139(C).
    8. Andrea Riganti, 2021. "Containing costs in the Italian local healthcare market," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1001-1014, May.
    9. Noto, Guido & Belardi, Paolo & Vainieri, Milena, 2020. "Unintended consequences of expenditure targets on resource allocation in health systems," Health Policy, Elsevier, vol. 124(4), pages 462-469.
    10. Luigi Cajazzo & Francesco Longo, 2018. "Reti sanitarie: distinte finalit? e assetti. Reti di patologia e reti di presa in carico in Lombardia," MECOSAN, FrancoAngeli Editore, vol. 2018(107), pages 99-120.
    11. Mauro, Marianna & Maresso, Anna & Guglielmo, Annamaria, 2017. "Health decentralization at a dead-end: towards new recovery plans for Italian hospitals," LSE Research Online Documents on Economics 74066, London School of Economics and Political Science, LSE Library.

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