The variations between the notion of essential levels of health care (lea) and the meaning of minimal levels characterised the 90s in Italy and was resolved, in health legislation, with the choice of the Lea and their determination by decree. At the constitutional level, the notion of essential levels of services was confirmed by the constitutional revision in 2001. The paper runs through the steps of this process, the underlying meanings, showing how the notion of essential levels is closely linked to the existence of a national health service, binding together the different regional health services, characterised by their centripetal structure, with the exception of the Region of Lombardia.only subscribers can see the full article

In the paper the author analyses the Italian Health spending in relation to public spending, and proposes a new accountability pact between central government and the regions, aimed at relaunching the National Health Service. Following an historical overview of the foundation of the Nhs and the reforms in the 70s and 90s, the relation between funding and spending from 1999 to 2004 is analysed in the light of documents produced by Institutions and Research Institutes, and compared with other European countries. The paper also presents a detailed analysis of health legislation concerning the regions adherence to the Stability Pact, the agreements signed at the State-Region Conference and the critical financial situations presently registered. Lastly, it examines article 119 of Title V of the Constitution and the new funding system of local authorities which it introduces.only subscribers can see the full article