Health Systems and Health Reforms in Europe: the Case of Italy

National Health Service systems are based on the principle of ensuring equal opportunities of access to services with the guarantee of equal standards for equal need, irrespective of the socio-economic circumstances of the individuals and of where they live. In recent years, many NHS countries, such as Italy, the United Kingdom and Spain have been shifting the provision of health services to sub-national entities (e.g. regions, provinces), defending the equity principle through the introduction of qualitative and quantitative standards set by national legislation and centrally monitored. In this context, the article summarises the reform processes developed in the last thirty years within the Italian NHS and focuses on more recent developments with particular reference to the enlargement of the fiscal autonomy of sub-national governments and the design of equalising transfers. From this point of view, the Italian case is illustrative of the economic and political diffi culties in implementing the insights provided by the theory of fiscal federalism in a country marked by stark territorial disparities.