Decentralization process of the NHS and evolution of inter-regional equity in health care in the period 2001-2012

The policies pursued both at the international and national levels have brought to the fore the concept of governance decentralization of health-care systems. In Italy, in particular, with the approval of legislative decree n. 56/2000 on fiscal federalism and the amendments to Title V of the Constitution (Const. Law n. 3/2001), the Regions have obtained wider political, administrative, organizational and management competencies also in health care. At the international level, several studies have examined the issue of equity in a decentralized health-care system. In the Italian context, this also involves the provision of essential levels of health care (LEAs) across Regions. Equity is a constitutional principle, pursued by the central level and monitored through the set of indicators of the “LEA Grid” (Griglia LEA). Starting from the “LEA Grid” indicators, through a multidimensional analysis by principal components, the study analyzes the evolution of inter-regional equity in the provision of health care (prevention, hospital care, outpatient care) between 2001 and 2012, when the process of health-care decentralization became more established. In line with the international literature, this analysis shows a significant inter-regional heterogeneity. In particular, it highlights: 1) an interregional differentiation with respect to the principal components defined “vaccination coverage”, “hospital care performance” and “outpatient care for the disabled”; 2) a persistent differentiation in “hospital care” between central-northern and southern regions; 3) a negative trend for the autonomous regions and provinces both in the provision of “hospital care” and “vaccination coverage”. The results of the study, innovative for equity dimensions explored and data available, justify the central government's intervention as guarantor of territorial equity with respect to the provision of health care