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A note on standard costs criteria for allocating the Italian national health fund to Regions

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  • Alessandro Petretto

Abstract

The funding of National Health Service in Italy follows a top-down two stages decentralized system, according to which the central Government feeds the National health-fund with specific taxes and distributes it among Regions. Further, each Region funds the so called Essential levels of Assistance (LEA) expenditures of its local health authorities (Aziendesanitarie locali, ASL). This mechanism pursues equity aims, but it can be, as well, efficiency enhancing if based on standardized quantities, hence on a fixed-price type transfer, i.e. established ex-ante independently of actual expenditures and costs. This note provides a technical analysis of possible allocation criteria with this purpose, and, at the same time, coherent with the procedure established by D.L. 68/2011. The aim is at establishing feasible analytical procedures for combining both equity and cost-efficiency concerns in defining the distribution formula. The idea is to introduce in the latter some incentive elements, even if only as signals, for boosting Regions to control unitary costs of health-care services, besides to produce and provide adequate levels of them.

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  • Alessandro Petretto, 2014. "A note on standard costs criteria for allocating the Italian national health fund to Regions," ECONOMIA PUBBLICA, FrancoAngeli Editore, vol. 2014(2), pages 5-21.
    • Handle: RePEc:fan:epepep:v:html10.3280/ep2014-002001
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    References listed on IDEAS

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    1. Enza Caruso & Nerina Dirindin, 2012. "Health care and fiscal federalism: Paradoxes of recent reform in Italy," Politica economica, Società editrice il Mulino, issue 2, pages 169-196.
    2. Alessandro Petretto, 2013. "On the Fuzzy Boundaries between Public and Private in Health-Care Organization and Funding Systems," Rivista di Politica Economica, SIPI Spa, issue 1, pages 327-370, January-M.
    3. Alessandro Petretto, 2013. "Need Equalization Transfers and Productive Efficiency of Local Governments," Rivista italiana degli economisti, Società editrice il Mulino, issue 1, pages 25-46.
    4. Fabio Pammolli & Nicola Carmine Salerno, 2011. "Federalismo e riparto del Fsn-2011: Much Ado About Nothing?," Working Papers CERM 01-2011, Competitività, Regole, Mercati (CERM).
    5. Fabio Pammolli & Nicola Carmine Salerno, 2010. "I numeri del Federalismo in Sanità - Benchmarking e Standard su profili di spesa sanitaria per età," Working Papers CERM 03-2010, Competitività, Regole, Mercati (CERM).
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    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism

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