Institute of Public Health and Preventive Medicine, Catholic University Sacro Cuore Rome, Largo Francesco Vito, 1, 00168 Roma, Italy.
Health Policy. 2012 Jun;106(1):10-6. doi: 10.1016/j.healthpol.2012.04.003. Epub 2012 Apr 30.
The global economic and financial crisis is having and impact on the Italian healthcare system which is undergoing a devolution process from the central government to regions and where about one third of the regional governments (mainly in the central and southern part of the country) are facing large financial deficits. The paper briefly describes the current macro scenario and the main responses taken to face the crisis and highlights the downside risks of introducing "linear" cuts in the allocation of resources. While justified by the risk of a national debt default, present fiscal policies might increase inequalities in access to care, deteriorate overall health indicators and population wellbeing, and sharpen existing difference in the quality of care between regions. Preliminary evidence shows that the crisis is affecting the quality of nutrition and the incidence of psychiatric disorders. During this difficult financial situation Italy is also facing the risk of a major reduction in investments for preventive medicine, Evidence Based Medicine infrastructures, health information systems and physical capital renewal. This cost-cutting strategy may have negative long term consequences Also, important achievement in terms of limiting waiting lists, improving continuity of care and patients' centeredness, and promoting integration between social and health care may be negatively affected by unprecedented resources' cuts. It is essential that in such a period of public funding constraints health authorities monitor incidence of diseases and access to care of the most vulnerable groups and specifically target interventions to those who may be disproportionally hit by the crisis.
全球经济和金融危机正在对意大利医疗保健系统产生影响，该系统正经历着从中央政府向地区的权力下放过程，大约三分之一的地区政府（主要在该国中部和南部）面临着巨大的财政赤字。本文简要描述了当前的宏观形势以及为应对危机而采取的主要措施，并强调了在资源配置中引入“线性”削减的不利风险。虽然引入“线性”削减的做法是出于国家债务违约风险的考虑，但当前的财政政策可能会导致获得医疗保健服务的不平等加剧，整体健康指标和人口福利恶化，以及地区间医疗服务质量的现有差距进一步扩大。初步证据表明，这场危机正在影响营养质量和精神疾病的发病率。在这种困难的财政形势下，意大利还面临着预防医学、循证医学基础设施、卫生信息系统和有形资本更新投资大幅减少的风险。这种削减成本的策略可能会产生长期的负面影响。此外，在限制候诊名单、改善医疗连续性和以患者为中心以及促进社会和医疗保健整合方面的重要成就，也可能因前所未有的资源削减而受到负面影响。在公共资金紧张的时期，卫生当局必须监测最弱势群体的疾病发病率和获得医疗保健的情况，并特别针对那些可能因危机而受到不成比例影响的人群进行干预，这一点至关重要。
