The Italian hospital system

Over the last decade two reforms have affected the Italian hospital system, one introducing market mechanisms, the other concerning the tools of planning and expense control assigned to the regional governments. The paper summarizes these institutional changes and describes the evolution of the structure and the activity of the hospital system, with a focus on the differences between regions. It highlights the following: (1) the reduction in the number of hospitals and hospital beds and the gap between regions in terms of hospital beds per capita; (2) the growth in personnel compared with the number of hospital beds; (3) the stationarity of admissions since the end of the nineties and the growth in the share of those in day hospital; (4) the greater number of admissions in southern regions, especially for inappropriate or less complex treatment, and the high level of migration towards northern hospitals; (5) with reference to costs, increasing returns to scale up to a given hospital size, which is larger, the more complex the courses of treatment provided; (6) the differences between regions in costs which are affected by the size of facilities and their type of specialization.