Accounting and funding of pharmaceuticals. Purpose, structure and management of the File F in nine Italian regions

This paper aims at providing an indepth analysis of the role of the File F, to provide a systematized knowledge of the mechanisms for accounting and funding of pharmaceuticals in Italy. File F is an information flow originally implemented for regulating inter-regional mobility. It has been differently modified by Regions, and in principle it has over time become a tool for monitoring the use of drugs, for controlling pharmaceutical expenditure and for providing ad hoc funding for specific pharmaceuticals. Nine Regions were investigated and a substantial cross-regional variability has emerged. Policy implications, concerning the relationships between the Central and Regional Governments, the actions Regions and the impact of File F on the economic performance of health care organizations are discussed on the ground of the evidence collected.