Getting health reforms right: what lessons from an Italian case?

Over the past few years (2001-2007), the Italian National Health Service has been undergoing an important process of decentralization with a significant transfer of powers and responsibilities from the central government to the Regions. In this context, a particularly innovative example is represented by the case of Marche Region that extensively reformed its health-care system. For the analysis of this case, we used a theoretical framework that describes a health-care system in terms of components and goals. Policy-makers can act on the structural components of the system influencing the behaviour of individuals and organizations in order to lead the system towards the achievement of key performance goals. Marche regional Government was able to improve the system in crucial areas (clinical appropriateness and economic equilibrium) by intervening on institutional arrangements (particularly on the number and dimension of health-care delivery organizations) and on key control knobs (particularly planning and control mechanisms and the information system). Some conditions have allowed Marche policy-maker to successfully carry out this extensive process of reforms, particularly: (1) a shared sense of urgency; (2) agreement on the identification of problems and on the relative reform strategies to adopt; (3) coordination of all change strategies through a precise and clear long-term plan aimed at developing an integrated health-care delivery network.