JANUARY

ITALY
although the degree of evolution is varied across regions. Some regions are also trying to set up disease
management programs based on the chronic care model.
The most recent Pact for Health, signed in July 2014, is a significant step toward care integration (see below):
all regions must establish “primary care complex units” (Unità Complesse di Cure Primarie) involving GPs,
specialists, nurses, and social workers.
Given that, traditionally, Italian GPs work in solo practice, shifting to this new organizational arrangement will
require considerable effort. To further promote integration and adoption of multidisciplinary teams, medical
homes are being encouraged in some regions. (Tuscany and Emilia-Romagna have invested considerable
resources in activating and promoting medical homes. In Emilia-Romagna, for example, there are currently
62 medical homes providing multispecialty care to approximately 1 million people.)
What is the status of electronic health records?
The New Health Information System has been implemented incrementally since 2002 to establish a universal
system of electronic records connecting every level of care. It provides information on the services, resource
use, and costs, but does not cover all areas of health care; in particular, primary care is not covered, while
hospital, emergency, outpatient specialist, residential and palliative care, and pharmaceuticals are. It currently
contains administrative information on care delivered, as medical information appears more difficult to gather.
No unique patient identifier exists at the national level.
A core component of the New Health Information System is the nationwide clinical coding program known as
“bricks,” one of the most mature elements of Italy’s developing electronic health program. It aims at defining
a common language to classify and codify concepts; at sharing methodologies for measuring quality, efficiency,
and appropriateness of care; and at allowing an efficient exchange of information between the national level
and regional authorities.
Some regions have developed computerized networks to facilitate communication between physicians,
pediatricians, hospitals, and territorial services and to improve continuity of care. These networks allow
automatic transfer of patient registers, services provided, prescriptions for specialist visits and diagnostics, and
laboratory and radiology test outcomes. A few regions also have developed a personal electronic health record,
accessible by patients, that contains all patient medical information, such as outpatient specialty care results,
medical prescriptions, and hospital discharge instructions. Personal electronic health records should provide
support to patients and clinicians across the whole process of care but diffusion is still limited.
There is also a slow movement from paper to electronic prescriptions. By the end of 2014, 80 percent of all
prescriptions (drugs and specialist care) were to be issued electronically, but only five regions declared that they
were able to reach the goal on time.
How are costs contained?
Containing health costs is a core concern of central government, as Italy’s public debt is among the highest in
industrialized nations. Fiscal capacity varies greatly across regions. To meet cost containment objectives, the
central government can impose recovery plans on regions with health care expenditure deficits. These identify
tools and measures needed to achieve economic balance: revision of hospital and diagnostic fees, reduction of
the number of beds, increased copayments for pharmaceuticals, and reduction of human resources through
limited turnover.
The Agency for Regional Health Services, in collaboration with the Ministry of Health, has authority to conduct
health technology assessments and implement its findings at the regional level, but these are not yet formalized
or undertaken systematically. Few regional health technology assessment agencies currently exist, and their
primary function is to evaluate individual technologies. Assessments are not mandatory for new or referred
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The Commonwealth Fund