Healthcare reform and disease management in Italy - Promoting the effectiveness and appropriateness of health service use

The 1999 reform of the Italian healthcare system has softened the effects o f the 1992 shift to market mechanisms and competition within healthcare by promoting cooperation and partnerships among providers and Local Health Uni ts (LHUs). In addition, it has facilitated the completion of transfering or ganizational and financial responsibility to the regional governments. Such health policy developments require both the introduction of administra tive tools, which stimulates integration, and the design of a coherent poli cy for quality of care. A 3-fold integration between healthcare and social services has been promoted to tackle the introduction of administrative too ls: institutional integration between municipalities and LHUs, managerial i ntegration at the district level for the provision of primary care and non- hospital care, and professional integration between healthcare professional s. A similar approach has characterized the policy for quality of care: an essential benefit package is to be identified as a guarantee to all citizen s, practice guidelines will be developed and implemented and an accreditati on process is underway. Implementation issues aside, effective introduction of the suggested tools requires careful planning and organization of the system and, above all, co ordinated interventions at the 3 levels of healthcare provision (i.e. the m acro, intermediary and micro levels). Governments, policy makers, health services researchers and analysts are ac tively engaged in an exhaustive search for new policy instruments for effec tively tackling the challenges that healthcare systems are appearing to fac e worldwide, at the economic, administrative and clinical levels. These cha llenges include cost containment, promotion of efficiency and effectiveness , and the design of an administrative structure which balances central cont rol and local autonomy decision making about resource allocation and their use in healthcare. Within this context, management of chronic diseases is possibly one of the major challenges that healthcare systems have to face. The slow and progres sive evolution of these conditions implies different patient needs, requiri ng a range of competencies and skills from health professionals and variabl e intensity of care. The promotion of increased coordination and continuity of care among health services is the key to the effective and efficient ma nagement of patients with chronic diseases. In principle, these goals should be achievable in two ways: (i) identifying and adopting administrative/financing tools, which stimulate integration r ather than fragmentation of care; and (ii) designing a coherent policy for quality of care. This paper outlines how these two aspects were addressed i n the recent reform of the Italian National Health Service (NHS).