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1.
The origins
The pathway toward
the implement the National Health System characterized by business and
manager criteria has been marked by two basic breakthroughs represented
by the great 1992 and 1999 reformation acts.
Till 1968 the safeguard
of the health right - sanctioned by art. 32 Constitution - laid over
the several assurance-mutualistic and welfare bodies that warranted,
but with serious lacks, the health assistance to the enrolled workers,
without putting in act preventive-diagnostic kind interventions and
compelling State to cover the ever frequent economic gaps, mainly as
regard to the hospital expenditure.
By the means of the
act n.132, on February 12th 1968, the Hospital Bodies established and
their management was entrusted to a Board of Directors named by the
Local Bodies: Regions, Provinces and Municipalities. Bodies had organization
autonomy but not the financial one. The consequence of this setting
out was the progressive increase in expenditures that, on the other
side, did not lead to better services. When in 1970 it went into force
the Regional Body, it was implemented mini-reformations trending to
put in act the provisions of Constitution both as regard to the right
to health for all citizens and as regard to the regional autonomies,
by transferring the State administrative functions to Regions, in view
of a transformation of the mutualistic bodies, for which they proceed
to liquidation, into instrumental bodies of Regions (1).
2.
Establishment of the National Health Service
By the means of the
great reformation act n. 833 on December 23rd 1978 it was established
the National Health Service: the whole of functions, structures, services
and activities destined to promotion, preservation and recover of the
physical and psychic health of the entire population. The intent was
that of putting at the centre of the National Health System the citizen,
that had an absolute right to health that enclosed not only the cure
of diseases but also their prevention and control.
Furthermore it was warranted
to citizen a greater participation even by the means of all units, centres,
institutions and volunteer associations to whom it was acknowledged
an active role within the welfare sector (2).
The establishment of
the Local Health Units marked the passage to the new Health Assistance
System. Even if having a certain autonomy, the Local Health Units were
the operative bodies of the municipalities, and therefore still strictly
bound by a political-kind management.
The financing of the
services performed by the National Health Service was almost all on
charge of the central State that provided for by the means of the established
National Health Fund, yearly determined by the means of the law of approval
of the State Financial Act. By comparing the economic data concerning
the new system introduced with the reformation act and the former mutualistic
system, it has not be detected a bettering in deficits, that instead
increased notwithstanding the attempts to correct them.
The motivation for
Local Health Units 'economic' failure must be searched in:
- the lack of links
between the state and the local bodies health and financial policies;
- the lack of approval
of a National Health Plan allowing individualizing the real amount of
the financing to subsidize;
- in the steady scission
between the liability for expenditures and liability for the location
of the required financial resources
To all that it must
be added the citizens-users' dissatisfaction as regard to the quality
of the performed services, inhomogeneous per territory, with big gaps
between the North and South of the country and even among different
structures inside the same territory (3).
The morrow of the 833/1978
act it was immediately planted the need to go on deeper in the reorganization
of the health system, mainly by planting new services financing modalities
and that must start-off from the redefinition of the nature of the Local
Health Units (4). Indeed the National Health Service model created by
the 833/78 act was an already obsolete product when it appeared, and
overcome by the novelties emerged national and international level.
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