Lega Federico, Sargiacomo Massimo, Ianni Luca
Bocconi University and SDA School of Management, Milan, Italy.
Health Serv Manage Res. 2010 Nov;23(4):172-80. doi: 10.1258/hsmr.2010.010006.
In this paper, we aim to discuss the implications and lessons that can be learnt from the ongoing process of federalism affecting the Italian National Health System (INHS). Many countries are currently taking decisions concerning the decentralization or re-centralization of their health-care systems, with several key issues that are illustrated in the recent history of the INHS. The decentralization process of INHS has produced mixed results, as some regions took advantage of it to strengthen their systems, whereas others were not capable of developing an effective steering role. We argue that the mutual reinforcement of the decentralization and recentralization processes is not paradoxical, but is actually an effective way for the State to maintain control over the equity and efficiency of its health-care system while decentralizing at a regional level. In this perspective, we provide evidence backing up some of the assumptions made in previous works as well as new food-for thought - specifically on how governmentality and federalism should meet - to reshape the debate on decentralization in health care.
在本文中，我们旨在探讨从影响意大利国家卫生系统（INHS）的联邦制进程中可以汲取的启示和教训。目前，许多国家正在就其医疗保健系统的分权或重新集权做出决策，意大利国家卫生系统的近期历史就说明了几个关键问题。意大利国家卫生系统的分权进程产生了喜忧参半的结果，一些地区借此加强了其系统，而另一些地区则未能发挥有效的指导作用。我们认为，分权和重新集权进程的相互强化并非自相矛盾，实际上是国家在区域层面进行分权的同时，维持对其医疗保健系统公平性和效率控制的有效方式。从这一角度出发，我们提供证据支持先前研究中的一些假设，并提出新的思考方向——特别是关于治理与联邦制应如何结合——以重塑关于医疗保健分权的辩论。
