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The role of socio-economic determinants in the interregional allocation of healthcare resources: Some insights from the 2023 reform in the Italian NHS

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  • Fantozzi, Roberto
  • Gabriele, Stefania
  • Zanardi, Alberto

Abstract

This paper discusses a reform recently implemented in the Italian National Health Service, aimed at adding some socio-economic indicators to the criteria adopted for allocating healthcare funding to Regions. The reform is based on international experience in healthcare financing in decentralized settings and provides a case study of special interest since Italy is a country with significant territorial disparities and severe budget constraints. The paper first discusses the long-standing debate between Italian Regions which led to the reform. Second, it reviews the main features of the reform which provides for the inclusion of socio-economic indicators via a simplified formula. Moreover, a possible revision of the reform is proposed, fully exploiting the information on the heterogeneity of health needs according to age and socio-economic indicators. By integrating the information on deprivation inside the risk adjustment mechanism, the weight of the different drivers is determined by the distribution of needs and not on a discretionary basis. Simulating the proposed revision suggests that more resources could be allocated to the Regions with higher levels of deprivation compared to a scenario that closely replicates the reform.

Suggested Citation

  • Fantozzi, Roberto & Gabriele, Stefania & Zanardi, Alberto, 2025. "The role of socio-economic determinants in the interregional allocation of healthcare resources: Some insights from the 2023 reform in the Italian NHS," Health Policy, Elsevier, vol. 152(C).
    • Handle: RePEc:eee:hepoli:v:152:y:2025:i:c:s0168851024002501
    DOI: 10.1016/j.healthpol.2024.105240
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    References listed on IDEAS

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    1. Cerniglia, Floriana & Longaretti, Riccarda & Zanardi, Alberto, 2021. "How to design decentralisation to curb secessionist pressures? Top-down vs. bottom-up reforms," Structural Change and Economic Dynamics, Elsevier, vol. 58(C), pages 377-390.
    2. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    3. Harvey Galper & Kim Rueben & Richard Auxier & Amanda Eng, 2014. "Municipal Debt: What Does It Buy and Who Benefits?," National Tax Journal, National Tax Association;National Tax Journal, vol. 67(4), pages 901-924, December.
    4. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845, Elsevier.
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    More about this item

    Keywords

    Healthcare; Resource allocation; National Health Service; Italy;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare

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