Italian health care reform

It is remarkable how health care systems, created over decades and influenced by very different cultures exhibit similar problems. Most health care systems are compartmentalised with managers at margins responding to perverse incentives and seeking to shift patients and costs onto rival organisations. Decision makers behave selfishly, considering the welfare of their own organisations rather than those of the health care system as a whole, and in the absence if evidence about the cost-effectiveness of competing treatments. Not only are the problems similar across health care systems, their resolution by politicians is also tackled in ways which are common. Thus in Italy the language and reforms of the UK NHS is affecting policy. The UK management reforms of the mid-1980s are now being translated into Italian innovations which include new contracts and performance related policy. The Italian GP contract has been altered and there is a desire to improve the efficiency of the supply side. The defects of the Italian health care system and their reform to produce health gains at lower cost are not well informed by evidence and, like the UK reforms, policy often appears to be conceived hastily and poorly evaluated. The lessons to be learnt from this paper are that many of the problems of health care systems with very different structures are common and there are few proven methods of resolving them.