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Abstract
At the time of its inception, in 1978, prevention and primary care were set as fundamental pillars of the Italian National Health Service (NHS), emphasizing the collective and social dimension of health. These principles were progressively neglected over the following four decades. Marketization, managed competition and managerialization privileged the individualized, highly specialized healthcare services mainly provided in hospitals, to the detriment of local outpatient and primary care services. After 2008–09, austerity policies exacerbated this situation determining under-financing as well as structural and staff shortages, while increasing tensions arose between the central government and Regions in the decentralized NHS. In 2020–21, the pandemic highlighted these critical issues. The need to develop a universal and strong outpatient, primary and community care system became evident in order to ensure the appropriateness and quality of foundational health services. This requires the State to play a more prominent role in the NHS governance.
Notes
1 A Prospective Payment System (PPS) is a method of reimbursement in which the provider payment is made based on a predetermined and fixed amount for a particular service. The amount is calculated according to the classification system of that service. ‘Diagnosis-related groups’ is a method of classification used for inpatient hospital services, which was first introduced in the US Medicare program in 1982 and then adopted in many other countries. It provides strong incentives for providers to control costs, either by managing the number and type of services being provided or minimizing the length of hospital stay. However, it may have negative consequences on the quality of care, because providers could excessively reduce the length of stay or the delivery of necessary services in order to increase profit from the fixed reimbursement (Fetter, Citation1991).