Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, via Roentgen, 1, 20136 Milano, Italy.
Health Policy. 2012 Dec;108(2-3):194-202. doi: 10.1016/j.healthpol.2012.09.017. Epub 2012 Oct 23.
The Italian National Healthcare System (NHS) is one of the most decentralised systems since the devolution reform approved in 2001. HTA is spreading as an important tool for decision-making processes both at central and local levels. The aims of this study were to review the state of the health technology assessment (HTA) programmes in Italy - with a focus on regional and central initiatives - and to discuss consequences of a multi-level structure of HTA agencies in highly regionalised healthcare systems.
Our method combined documentary review with interviews. We reviewed scientific literature about HTA's activities in decentralised systems, legislative and administrative documents from national as well as regional authorities. Semi-structured interviews were conducted with 18 key individuals associated with HTA both at the national and regional levels. Data on HTA programmes implemented or under development in nine regions were collected and analysed according to key principles for the improved conduct of health technology assessments for resource allocation decisions.
HTA is in the early stage of development in Italy, although with great heterogeneity across regions. The National Agency for Health Services has certainly contributed to HTA diffusion through supporting and training activities. However, the multi-level structure of HTA in Italy has not yet provided full coordination and harmonisation of practices and outcomes across the country, with a consequent exacerbate inequality of access to services and technologies.
There is probably need to rethink the multi-layer organizational framework of HTA in Italy by leveraging on current knowledge and efficient redistribution of activities across regions. We would advise for different jurisdictions playing different roles while achieving similar health outcomes for their patients, rather than jurisdictions aiming at doing exactly the same things resulting in unequal access to healthcare service provision.
意大利国家医疗保健系统（NHS）是自 2001 年批准权力下放改革以来最分散的系统之一。HTA 作为中央和地方各级决策过程的重要工具正在普及。本研究的目的是审查意大利卫生技术评估（HTA）计划的现状-重点关注区域和中央倡议-并讨论高度区域化医疗保健系统中多级别 HTA 机构结构的后果。
我们的方法将文献回顾与访谈相结合。我们回顾了关于分散系统中 HTA 活动的科学文献，以及来自国家和地区当局的立法和行政文件。我们在国家和地区两级与 HTA 相关的 18 位关键人员进行了半结构化访谈。根据资源分配决策中改进卫生技术评估的主要原则，收集和分析了在九个地区实施或正在开发的 HTA 计划的数据。
HTA 在意大利处于发展的早期阶段，尽管各地区之间存在很大的异质性。国家卫生服务机构通过支持和培训活动肯定为 HTA 的传播做出了贡献。然而，意大利 HTA 的多层次结构尚未在全国范围内充分协调和统一实践和结果，从而加剧了服务和技术获取的不平等。
可能需要重新考虑意大利 HTA 的多层次组织框架，利用当前的知识和在各地区之间有效分配活动。我们建议不同的司法管辖区在为患者实现类似的健康结果的同时发挥不同的作用，而不是追求完全相同的事情，导致医疗保健服务提供的机会不平等。
