Tax federalism in Italy is around the corner, while the gap between North and South increases. In the health and welfare system the gap concerns both essential service levels and the economic-financial situation. Analysing the running costs in the last few years and some indicators of the state of organisation of the regional health services, we can see how the deficit in many Regions is not due to under-financing so much as to different planning and organisational choices. In the less virtuous Regions there is an extremely close connection between deficits and distortions in the supply of seronly subscribers can see the full article

The article analyses the theme of institutional accreditation in Italy, its implementation problems at the regional level in the framework provided in national legislation, and the experience of two regions, Emilia Romagna and Lombardia, which developed different accreditation models. In order to do this, national indications and the role assigned by the norm to the regions on accreditation are considered, together with the delays of the central level and those connected to the process of power devolution to the regions culminating in the modification of Title V of the Constitution. The analysis of some economic, cultural and political problems within the regions, which have influenced the modalities and start-up times of accreditation policies, introduces the accreditation models of Emilia Romagna and Lombardia, that are examined on the basis of different responses given to common critical aspects.only subscribers can see the full article

Epidemiological data are not sufficient to describe and explain the health conditions of the immigrant population living in Italy with or without an official stay permit. Present information flows are numerous but insufficient and inadequate, lacking any connection with the survey of socio-demographic data and the needs of some groups of users who are in particularly vulnerable conditions. Through the results of a study conducted on data of the Social Information System of the Caritas Diocesana of Rome, the necessity to support and promote the creation of integrated socio-health information systems clearly emerges.only subscribers can see the full article

The heavy burden of health spending on elderly care is common-place in the preoccupations of policy makers and politicians, and is constantly the focus of media attention. The attention on this subject is however rather ambivalent: stress is not placed on the «physiology» of growth in investments for a part of society that «obviously» expresses several needs and is entitled to corresponding rights; the objective complexity of the problem is presented in such a way as to make the solutions appear increasingly more difficult and not due, with the consequent rise in cultural, political and cognitive marginalisation. Analysing four model scenarios, operative solutions, feasible through a participatory way, are indicated at both the local and general levels.only subscribers can see the full article

In the face of a growing quantity of reports, information, surveys, statistics, descriptions and projections on so many aspects of the health and social system in our country, we are gradually becoming more and more aware of the limits of such contributions. As a simple example from the various national sources that are easy to access, one might cite all the institutional web sites and/or data banks such as the National Statistical Institute (Istat, see, for example, the Annuario statistico italiano 2006, recently published and available entire online); the Ministry of Health, the Italian Agency of Drug (Aifa); the Istituto Superiore di Sanità; the Istituto Nazionale per l’Assicurazione contro gli Infortuni sul Lavoro; and the Interuniversity Consortium (Cineca - Arno Report). only subscribers can see the full article

The paper gives an overview of the historical evolution and characteristics of the s in Germany, the Uk and the Usa. The article also proposes an economic interpretation of differences between the three countries. Germany and the Uk, through different models, assure universal access to health services. In the Usa the residual role of public funding doesn’t manage to make up for shortcoming in the private sector, leaving almost a third of the population without any insurance or with insufficient insurance coverage. High health spending in the Usa, incrementing the diffusion of increasingly expensive new technologies and therapeutic approaches, can put universalistic systems under pressure. To maintain the present structure of European health systems, it is necessary to manage the diffusion of new technologies.only subscribers can see the full article

In the 1990s decentring the national health service was the signal for processes of institutional differentiation between the Regions, from which emerged three models of governance for the health system. In recent years, however, most of the Regions have partially converged on regulatory solutions based on principles of cooperation and integration between the health organisations, pursued through negotiating or centralised planning. This trend is probably a response to the common problem of control of expenditure and financial retrenching, which, in the most critical cases, risks heavily conditioning regional autonomy, setting off process of recentralisation of the health service.only subscribers can see the full article

Rare diseases are an heterogeneous set of human pathologies whose common features are the low frequency rate in the population (under 5:10,000, according to European criteria) and serious social and health problems associated with such a low frequency. Their number involves a consistent part of the population (approx. 6,000). These pathologies are little known and studied, often chronic and crippling, for which social and health interventions must include support for life and work choices to persons affected. Important public health initiatives are underway at both the national and international levels.only subscribers can see the full article

That health service costs tend to increase staggeringly is well known. The most recent forecast of PricewaterhouseCoopers Health Research Institute estimates a tripling of its impact on Gdp in the next fifteen years, reaching 21% in the USA and an average of 16% in other OECD countries. Italy’s relatively favourable position at 8.5% will tend to be eroded, if for no other reason than the worldwide tendency of health service consumption, supply systems and costs to converge. only subscribers can see the full article

The crisis of the State-nation led to a consolidation of sub-national levels of government. This reinforcement has conditioned recent developments in the welfare state, and particularly in health policy. With reference to the Italian case, the article illustrates the main changes brought into force by the reforms of 1992-93 and of 1999 in terms of the «regionalization» of the health system, and outlines the main steps that led to fiscal federalism, enhancing regional financial autonomy. The closing paragraph takes into consideration possible implications of the process of European integration and, more specifically, the adoption of the Open method of co-ordination on the evolution of the regional health systems.only subscribers can see the full article