Università Cattolica del Sacro Cuore.
CERGAS, Università Bocconi.
Health Syst Transit. 2022 Dec;24(4):1-236.
This analysis of the Italian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Italy has a regionalized National Health Service (SSN) that provides universal coverage largely free of charge at the point of delivery, though certain services and goods require a co-payment. Life expectancy in Italy is historically among the highest in the EU. However, regional differences in health indicators are marked, as well as in per capita spending, distribution of health professionals and in the quality of health services. Overall, Italy's health spending per capita is lower than the EU average and is among the lowest in western European countries. Private spending has increased in recent years, although this trend was halted in 2020 during the coronavirus disease 2019 (COVID-19) pandemic. A key focus of health policies in recent decades was to promote a shift away from unnecessary inpatient care, with a considerable reduction of acute hospital beds and stagnating overall growth in health personnel. However, this was not counterbalanced by a sufficient strengthening of community services in order to cope with the ageing population's needs and related chronic conditions burden. This had important repercussions during the COVID-19 emergency, as the health system felt the impact of previous reductions in hospital beds and capacity and underinvestment in community-based care. Reorganizing hospital and community care will require a strong alignment between central and regional authorities. The COVID-19 crisis also highlighted several issues pre-dating the pandemic that need to be addressed to improve the sustainability and resilience of the SSN. The main outstanding challenges for the health system are linked to addressing historic underinvestment in the health workforce, modernizing outdated infrastructure and equipment, and enhancing information infrastructure. Italy's National Recovery and Resilience Plan, underwritten by the Next Generation EU budget to assist with economic recovery from the COVID-19 pandemic, contains specific health sector priorities, such as strengthening the country's primary and community care, boosting capital investment and funding the digitalization of the health care system.
本报告分析了意大利卫生系统的近期组织和治理变化、卫生筹资、医疗服务提供、卫生改革和卫生系统绩效。意大利实行的是全国性的区域化卫生服务体系（SSN），基本提供免费的全民覆盖服务，仅在提供服务时收取少量费用。意大利的预期寿命在欧盟国家中一直处于较高水平。然而，其卫生指标的地区差异明显，人均支出、卫生专业人员分布和卫生服务质量也存在差异。总的来说，意大利的人均卫生支出低于欧盟平均水平，在西欧国家中处于较低水平。近年来，私人支出有所增加，但在 2019 年冠状病毒病（COVID-19）大流行期间，这一趋势在 2020 年停止。近几十年来，卫生政策的一个重点是促进从不必要的住院治疗转变，大量减少急性医院病床，并使卫生人员总数增长停滞。然而，社区服务并没有得到足够的加强，以满足人口老龄化和相关慢性病负担的需求。这在 COVID-19 紧急情况期间产生了重要影响，因为卫生系统感受到了之前减少医院床位和容量以及对社区护理投资不足的影响。要重组医院和社区护理，需要中央和地区当局之间的紧密协调。COVID-19 危机还突显了一些在大流行之前就存在的问题，需要加以解决，以提高 SSN 的可持续性和恢复力。卫生系统面临的主要挑战与卫生劳动力的历史投资不足、更新过时的基础设施和设备以及加强信息基础设施有关。意大利的国家复苏和恢复计划由欧盟下一代预算提供资金，旨在帮助意大利从 COVID-19 大流行中恢复经济，其中包含了卫生部门的具体优先事项，例如加强国家初级和社区护理、增加资本投资以及为卫生保健系统的数字化提供资金。
