## Health Care and its Financing in Italy: Issues and Reform Options

_IMF Working Papers, October 1, 2000_

## Source details

**Canonical URL:** [Health Care and its Financing in Italy: Issues and Reform Options](https://www.imf.org/en/publications/wp/issues/2016/12/30/health-care-and-its-financing-in-italy-issues-and-reform-options-3822)

## Other formats

- [Markdown version](/en/publications/wp/issues/2016/12/30/health-care-and-its-financing-in-italy-issues-and-reform-options-3822/index.md)
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## Bibliographic details
- Authors: Franco Reviglio
- Published: October 1, 2000
- Series: IMF Working Papers
- DOI: https://doi.org/10.5089/9781451858099.001

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### Summary
- In Italy, health care budget ceilings are not effective.
- The poor control by the central government results in:
  - excessive use of expensive inputs,
  - long waiting lines for medical procedures,
  - the emergence of large arrears to suppliers and commercial banks.
- To fully gain the benefits of its decentralized structure, Italy needs to:
  - clarify the rules of the game and strengthen controls on local health authorities,
  - extend full fiscal responsibility to local governments on both the expenditure and revenue sides.
- The central government should be involved neither in decisions on the services that local governments should supply, nor in their planning and management.

### Key Findings
- Budget ceilings at the national level are ineffective in constraining health care spending.
- Weak central-government control contributes directly to inefficiencies and financial strains in the health sector:
  - excessive use of expensive inputs,
  - long waiting lines for medical procedures,
  - large arrears to suppliers and commercial banks.

### Policy Recommendations
- Clarify the rules governing the decentralized health system.
- Strengthen controls and oversight of local health authorities.
- Assign full fiscal responsibility to local governments on:
  - the expenditure side,
  - the revenue side.
- Remove central government involvement in:
  - decisions on the specific services local governments should supply,
  - the planning and management of local health services.

### Subject and Keywords
- Subject: Arrears, Expenditure, External debt, Health, Health care, Health care spending
- Keywords: accrual expenditure, Arrears, authorities claim, expenditure overrun, expenditure side, expenditure undervaluation, government, government debt-accounting problem, government funding, Health care, Health care spending, health indicator, health program manager, health sector deficit, lack of responsibility, Public health care in Italy, regional authorities, WP

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## Content in this bundle

- **Health Care and Its Financing in Italy:  Issues and Reform Options - WP/00/166**
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_Source: https://www.imf.org/en/publications/wp/issues/2016/12/30/health-care-and-its-financing-in-italy-issues-and-reform-options-3822_