Participants at this national roundtable embarked on their discussion by first observing that, over the last thirty years, the Italian National Health Service (Servizio Sanitario Nazionale – SSN) has assured generations of Italians a good standard of universally accessible services. Today, however, the system finds itself operating in different circumstances to the past due to technical, economic, and ethical factors. In particular: technical advances, together with demographic trends, have helped to extend the average life expectancy of Italians, thereby increasing demand for health services; economic constraints and limitations have come to play an increasingly important role in decisionmaking processes; and, lastly, ethical considerations are becoming more and more central to the sector.
It was suggested that in order to address these challenges, the Italian health system will need to be able to make progress in four key directions: continued improvement in the prevention of disease and the efficiency of health facilities; the reduction of disparities in performance; the formulation of a national health policy integrated with the country’s industrial priorities; and the simplification of bureaucracy.
Rationalizing the system’s resources was viewed as entailing the standardization and efficiency-boosting of “non-core” activities (facility management, procurement, and so on) as a matter of priority. At the same time, in order to move towards a greater personalization of the “core” activities of treatment and care, the health facilities model will need to be further developed through: increased accountability and autonomy of medical staff; the creation of new professional roles; the strengthening of IT and digital support tools; and the systematic introduction of monitoring, evaluation, and merit-rewarding mechanisms.
In addition, in order to prevent the system from becoming dangerously inelastic, it was felt advisable that controlled competitive elements be introduced, including via forms of public-private partnership, facilitating for instance the spread of supplementary private health insurance funds. Lastly, it was emphasized that a sustainable system cannot afford to neglect prevention, public education, and regard for the environment.
Reducing disparities in performance between different health facilities was characterized as primarily a moral imperative. Nevertheless, difficulties persist in Italy with respect to systematically measuring and assessing the efficiency and standard of various facilities. It was acknowledged, however, that introducing new monitoring methodologies and processes also supported by digital means is already on the government agenda and remains a priority for the coming years.
The health industry was recognized by the participants as an important engine of economic growth for Italy. To enhance its potential as such, it was deemed necessary to devise a national health policy integrated with the country’s industrial priorities. This was viewed as requiring a radical transformation, entailing that the healthcare system must change from being a simple cost center to become a center of investment and promotion of excellence. However, it was conceded that competitive advantages also risk being undermined by bureaucracy, giving rise to a need for simplification of the relevant regulatory framework and the reduction of time-to-market for new legislative developments.
In conclusion, it was stressed that the sustainability of Italy’s health system will depend on its ability to embrace change while resolving short-term problems and planning long-term development and innovation.