L’assistenza ospedaliera: modelli regionali e performance degli ospedali nel Servizio sanitario nazionale

[Machine translation] The organization of the provision of healthcare services, especially hospital services, has undergone a profound change in recent decades, in Italy as in many other countries. In particular, our National Health Service (SSN), while reaffirming the basic principle of universal coverage, has been affected by various reforms at the “macro” level, aimed at increasing the degree of autonomy and fiscal responsibility of regional governments, and at the “micro” level, introducing typical elements of the organizational models of “quasi-markets”, through the separation of funders from the providers of hospital services (vertical de-integration) and conferring management autonomy to public hospitals. This process has contributed to the creation of different regional health systems, each with its own characteristics in terms of the degree of vertical de-integration and the role attributed to private hospitals. , The article examines the main reforms of the NHS, focusing the analysis on the provision of hospital services, which alone accounts for almost 50% of total public health expenditure. The contribution aims to give a key to understanding these reforms through a theoretical-institutional framework, aimed at characterizing their potential effects on the hospital supply. It also seeks to provide an assessment of the current performance of the NHS, presenting some regional indicators relating to health outcomes, appropriateness and quality of the hospital services provided, which are then used to briefly discuss the possible links between the methods of implementing the reforms by the different regions and the performance of the respective health systems. The analysis does not seem to reveal a clear correlation between the adoption of a given organizational model and the observed results. This evidence suggests that the quality of institutions, policies and markets, responsible for the governance of regional health systems, plays a fundamental role in determining the improvements that can be achieved in terms of efficiency and equity.