IDEAS home Printed from https://ideas.repec.org/a/fan/mesame/vhtml10.3280-mesa2018-108002.html
   My bibliography  Save this article

Processo di decentramento del SSN ed evoluzione dell?equit? interregionale nell?assistenza sanitaria nel periodo 2001-2012

Author

Listed:
  • Antonio Nuzzo
  • Flavia Carle
  • Eugenio Anessi Pessina

Abstract

Nel contesto dei servizi sanitari, le politiche condotte a livello sia internazionale sia nazionale hanno portato alla ribalta il concetto di decentramento dei sistemi di governance. In Italia, in particolare, con l?approvazione del D.Lgs. n. 56 del 2000 sul federalismo fiscale e la modifica del Titolo V della Costituzione (Legge Costituzionale n. 3 del 2001), le regioni hanno ottenuto maggiori competenze politicoamministrative, organizzative e gestionali anche in ambito sanitario. A livello internazionale diversi sono gli studi che hanno approfondito la tematica dell?equita all?interno di un sistema sanitario decentrato che, nel contesto italiano, si sostanzia nella garanzia di un?equa erogazione dei livelli essenziali di assistenza (LEA) tra le diverse regioni. L?equita rappresenta un principio costituzionale, perseguito dal livello centrale che ne valuta e monitora il rispetto, tra l?altro, attraverso il set di indicatori della Griglia LEA. A partire dagli indicatori della Griglia LEA, attraverso un?analisi multidimensionale per componenti principali, lo studio analizza l?evoluzione della differenziazione interregionale nell?assistenza sanitaria (prevenzione, assistenza ospedaliera, assistenza territoriale) tra il 2001 e il 2012, quando si e maggiormente sviluppato il processo di decentramento sanitario. In linea con la letteratura internazionale, questa analisi coglie l?esistenza di situazioni di differenziazione interregionale. Si osserva in particolare: 1) una differenziazione interregionale sulle componenti delle coperture vaccinali, della performance nell?assistenza ospedaliera e dell?assistenza distrettuale per disabili; 2) una persistente differenziazione nell?assistenza ospedaliera tra centro-nord e sud; 3) un trend in peggioramento per le regioni a statuto speciale e province autonome sia nell?erogazione di assistenza ospedaliera sia sulle coperture vaccinali. I risultati dello studio, innovativo per dimensioni dell?equita esplorate e dati a disposizione, giustificano l?intervento del livello centrale nel suo ruolo di garante dell?e- quit? territoriale rispetto all?erogazione dei livelli essenziali di assistenza.

Suggested Citation

  • Antonio Nuzzo & Flavia Carle & Eugenio Anessi Pessina, 2018. "Processo di decentramento del SSN ed evoluzione dell?equit? interregionale nell?assistenza sanitaria nel periodo 2001-2012," MECOSAN, FrancoAngeli Editore, vol. 2018(108), pages 9-34.
    • Handle: RePEc:fan:mesame:v:html10.3280/mesa2018-108002
    as

    Download full text from publisher

    File URL: http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=65040&Tipo=ArticoloPDF
    Download Restriction: Single articles can be downloaded buying download credits, for info: https://www.francoangeli.it/DownloadCredit
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Reinhard Busse & Tom Stargardt & Jonas Schreyögg, 2005. "Determining the “Health Benefit Basket” of the Statutory Health Insurance scheme in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(1), pages 30-36, November.
    2. Magnussen, Jon & Hagen, Terje P. & Kaarboe, Oddvar M., 2007. "Centralized or decentralized? A case study of Norwegian hospital reform," Social Science & Medicine, Elsevier, vol. 64(10), pages 2129-2137, May.
    3. Dolores Jimenez Rubio, 2011. "The impact of decentralization of health services on health outcomes: evidence from Canada," Applied Economics, Taylor & Francis Journals, vol. 43(26), pages 3907-3917.
    4. Jeremiah Hurley, 2001. "Ethics, Economics, and Public Financing of Health Care," Centre for Health Economics and Policy Analysis Working Paper Series 2001-07, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    5. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Economics and Management, Springer, vol. 10(3), pages 219-237, September.
    6. Tediosi, Fabrizio & Gabriele, Stefania & Longo, Francesco, 2009. "Governing decentralization in health care under tough budget constraint: What can we learn from the Italian experience?," Health Policy, Elsevier, vol. 90(2-3), pages 303-312, May.
    7. Toth, Federico, 2014. "How health care regionalisation in Italy is widening the North–South gap," Health Economics, Policy and Law, Cambridge University Press, vol. 9(3), pages 231-249, July.
    8. Dolores Jiménez‐Rubio & Peter C. Smith & Eddy Van Doorslaer, 2008. "Equity in health and health care in a decentralised context: evidence from Canada," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 377-392, March.
    9. Massimiliano Piacenza & Gilberto Turati, 2014. "Does Fiscal Discipline Towards Subnational Governments Affect Citizens' Well‐Being? Evidence On Health," Health Economics, John Wiley & Sons, Ltd., vol. 23(2), pages 199-224, February.
    10. Di Novi, C. & Piacenza, M. & Robone, S. & Turati, G., 2015. "How does fiscal decentralization affect within-regional disparities in well-being? Evidence from health inequalities in Italy," Health, Econometrics and Data Group (HEDG) Working Papers 15/23, HEDG, c/o Department of Economics, University of York.
    11. Robalino, David A. & Picazo, Oscar F. & Voetberg, Albertus, 2001. "Does fiscal decentralization improve health outcomes? - evidence from a cross-country analysis," Policy Research Working Paper Series 2565, The World Bank.
    12. George France & Francesco Taroni & Andrea Donatini, 2005. "The Italian health‐care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 187-202, September.
    13. Saltman, Richard B. & Bankauskaite, Vaida, 2006. "Conceptualizing decentralization in European health systems: a functional perspective," Health Economics, Policy and Law, Cambridge University Press, vol. 1(2), pages 127-147, April.
    14. Fattore, Giovanni, 1999. "Clarifying the scope of Italian NHS coverage. Is it feasible? Is it desirable?," Health Policy, Elsevier, vol. 50(1-2), pages 123-142, December.
    15. Soto, Victoria Eugenia & Farfan, Maria Isabel & Lorant, Vincent, 2012. "Fiscal decentralisation and infant mortality rate: The Colombian case," Social Science & Medicine, Elsevier, vol. 74(9), pages 1426-1434.
    16. Khaleghian, Peyvand, 2004. "Decentralization and public services: the case of immunization," Social Science & Medicine, Elsevier, vol. 59(1), pages 163-183, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Niccol? Persiani & Martina Giusti & Maria Jose Caldes & Afef Hagi, 2022. "Il contributo del management alla definizione della strategia di decentramento del Servizio Sanitario: il caso del Servizio Sanitario Tunisino," MECOSAN, FrancoAngeli Editore, vol. 2022(122), pages 85-103.
    2. Silvia Bruzzi & Enrico Ivaldi & Marta Santagata, 2022. "Measuring Regional Performance in the Italian NHS: Are Disparities Decreasing?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 159(3), pages 1057-1084, February.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Cavalieri, Marina & Ferrante, Livio, 2016. "Does fiscal decentralization improve health outcomes? Evidence from infant mortality in Italy," Social Science & Medicine, Elsevier, vol. 164(C), pages 74-88.
    2. Signorelli, C. & Odone, A. & Oradini-Alacreu, A. & Pelissero, G., 2020. "Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary," Health Policy, Elsevier, vol. 124(1), pages 69-74.
    3. Di Novi, Cinzia & Piacenza, Massimiliano & Robone, Silvana & Turati, Gilberto, 2019. "Does fiscal decentralization affect regional disparities in health? Quasi-experimental evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 78(C).
    4. Jiménez-Rubio, Dolores & García-Gómez, Pilar, 2017. "Decentralization of health care systems and health outcomes: Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 188(C), pages 69-81.
    5. Nakatani, Ryota & Zhang, Qianqian & Garcia Valdes, Isaura, 2023. "Health Expenditure Decentralization and Health Outcomes: The Importance of Governance," MPRA Paper 118062, University Library of Munich, Germany.
    6. Tediosi, Fabrizio & Gabriele, Stefania & Longo, Francesco, 2009. "Governing decentralization in health care under tough budget constraint: What can we learn from the Italian experience?," Health Policy, Elsevier, vol. 90(2-3), pages 303-312, May.
    7. Sumah, Anthony Mwinkaara & Baatiema, Leonard & Abimbola, Seye, 2016. "The impacts of decentralisation on health-related equity: A systematic review of the evidence," Health Policy, Elsevier, vol. 120(10), pages 1183-1192.
    8. Jiménez-Rubio, Dolores, 2011. "The impact of fiscal decentralization on infant mortality rates: Evidence from OECD countries," Social Science & Medicine, Elsevier, vol. 73(9), pages 1401-1407.
    9. Andreas P. Kyriacou & Oriol Roca-Sagalés, 2019. "Local Decentralization and the Quality of Public Services in Europe," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 145(2), pages 755-776, September.
    10. Alessandra Cepparulo & Luisa Giuriato, 2022. "The residential healthcare for the elderly in Italy: some considerations for post-COVID-19 policies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(4), pages 671-685, June.
    11. Vainieri, Milena & Vola, Federico & Gomez Soriano, Gregorio & Nuti, Sabina, 2016. "How to set challenging goals and conduct fair evaluation in regional public health systems. Insights from Valencia and Tuscany Regions," Health Policy, Elsevier, vol. 120(11), pages 1270-1278.
    12. Noto, Guido & Belardi, Paolo & Vainieri, Milena, 2020. "Unintended consequences of expenditure targets on resource allocation in health systems," Health Policy, Elsevier, vol. 124(4), pages 462-469.
    13. Martínez André & Rodríguez-Zamora Carolina, 2011. "An Evaluation of the 1997 Fiscal Decentralization Reform in Mexico: The Case of the Health Sector," Working Papers 2011-16, Banco de México.
    14. Manzoor Ahmed & Abdul Qayyum, 2023. "Decentralisation’s Effects on Health: Theory and Evidence from Balochistan, Pakistan," The Pakistan Development Review, Pakistan Institute of Development Economics, vol. 62(3), pages 331-356.
    15. Masayoshi Hayashi, 2011. "The effects of medical factors on transfer deficits in Public Assistance in Japan: a quantile regression analysis," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 287-307, December.
    16. Kis-Katos, Krisztina & Sjahrir, Bambang Suharnoko, 2017. "The impact of fiscal and political decentralization on local public investment in Indonesia," Journal of Comparative Economics, Elsevier, vol. 45(2), pages 344-365.
    17. Marcelo Castro & Enlinson Mattos & Fernanda Patriota, 2021. "The effects of health spending on the propagation of infectious diseases," Health Economics, John Wiley & Sons, Ltd., vol. 30(10), pages 2323-2344, September.
    18. Anila Channa & Jean-Paul Faguet, 2016. "Decentralization of Health and Education in Developing Countries: A Quality-Adjusted Review of the Empirical Literature," The World Bank Research Observer, World Bank, vol. 31(2), pages 199-241.
    19. Joan Costa-Font & Gilberto Turati, 2018. "Regional healthcare decentralization in unitary states: equal spending, equal satisfaction?," Regional Studies, Taylor & Francis Journals, vol. 52(7), pages 974-985, July.
    20. José-Ignacio Antón & Rafael Muñoz de Bustillo & Enrique Fernández Macías & Jesús Rivera, 2014. "Effects of health care decentralization in Spain from a citizens’ perspective," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 411-431, May.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:fan:mesame:v:html10.3280/mesa2018-108002. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Stefania Rosato (email available below). General contact details of provider: http://www.francoangeli.it/riviste/sommario.aspx?IDRivista=180 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.