JANUARY

ITALY
(France et al., 2005). All doctors under contract with the National Health Service must be certified, and all
National Health Service staff participate in compulsory continuing education. The National Commission for
Accreditation and Quality of Care is responsible for outlining the criteria used to select providers and for
evaluating regional accreditation models (including private hospitals), which vary considerably across the
system. These models do not usually include periodic reaccreditation.
Legislation passed during the 1990s covers three main components of quality: input (quality of infrastructure
and human resources); process (appropriateness and timeliness of interventions); and outcome (health status
and patient satisfaction) (Lo Scalzo et al., 2009).
National legislation requires all public health care providers to issue a “health service chart” with information on
service performance, quality indicators, waiting times, quality assurance strategies, and the process for patient
complaints. These charts also have been adopted by the private sector for its accreditation process, and must
be published annually, although dissemination methods are decided regionally. Most providers issue data
through leaflets and the Internet, while nurses and other medical staff are offered financial performance
incentives (linked to manager evaluations but not to publicly reported data).
The National Plan for Clinical Guidelines (Piano Nazionale Linee Guida) has been implemented in recent years
and has produced guidelines on topics ranging from cardiology to cancer prevention and from appropriate use
of antibiotics to cesarean delivery.
Some regions have introduced disease management programs, are experimenting with chronic care models
(refer to the section on coordination) and maintain registries, mainly for cancer patients and diabetes. No
national registries exist. Patient surveys are not used for quality control.
What is being done to reduce disparities?
Interregional inequity is a long-standing concern. The less affluent south trails the north in number of beds and
availability of advanced medical equipment, has more private facilities, and less-developed community care
services. Data show a rise in interregional mobility in the 1990s, with movement particularly from southern to
central and northern regions (France, 1997) and an increasing gap between the north and south (Toth, 2014).
Income-related disparities in self-reported health status are significant, though similar to those in the
Netherlands, Germany, and other European countries (Van Doorslaer and Koolman, 2004).
The National Health Plan for 2006–2008 cites overcoming large regional discrepancies in care quality as key
objective for reform. Directing EU resources toward health services in eight regions in the south was a first step
in 2007 in reducing this persistent variation. Regions receive a proportion of funding from an equalization fund
(the National Solidarity Fund), which aims to reduce inequalities. Aggregate funding for the regions is set by the
Ministry of the Economy and Finance, and the resource allocation mechanism is based on capitation adjusted
for demographic characteristics and use of health services by age and sex.
What is being done to promote delivery system integration and
care coordination?
Integration of health and social care services has recently improved, with a significant shift of long-term care
from institutions to the communities, with an emphasis on home care. Community home care establishes a
home care network that integrates the competencies of nurses, GPs, and specialist physicians with the needs
and involvement of the family. General practitioners oversee the home care network, liaise with social workers
and other sectors of care, and take responsibility for patient outcomes.
Regions have chronic patient management programs, dealing mainly with high-prevalence conditions such as
diabetes, congestive heart failure, and respiratory conditions. All programs involve different competencies
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