Control Systems in the Italian National Health Service and the Maintaining of the Principles of Universality, Equality and Equity: Avoiding Discrimination and “Exit” Phenomena

The Italian National Health Service (NHS) was responsible in 2015 for a public health spending equivalent of 14% of the total Italian public spending. It is funded from general taxation as health is treated as merit good. In recent years the Italian NHS has been subject to many restrictions to contain spending and rationalize the activity in the name of the efficiency and the effectiveness. The measures at national level and for each Regional Health Service (independent with the implementation of the health federalism in 2001) have been drawn up in accordance with the founding principles of the NHS in 1978: Universality, Equality and Equity. But the application in specific contexts "has put a strain on the needs of citizens", as emphasized in the "Report on the status and prospects of the NHS, in view of the sustainability of the system and to ensure the principles of universality, solidarity and equity "of May 2015 drawn up by the Standing Committee - Hygiene and Health of the Senate of the Italian Republic. The paper analyzes precisely the system of existing control mechanisms on the implementation at the local level of the national and regional measures to contain spending and rationalize the activity of the NHS. The paper evaluates the effectiveness or the "inability" of the control mechanisms to guarantee citizens the rights deriving from the principles of the NHS and to avoid discrimination and “exit” phenomena. The context of the study is the Regional Health Service of Emilia-Romagna with the measures adopted after 2010 to deal with the problems of waiting lists and the control of spending that in the area of the Bologna Local Health Authority it has meant the redirecting of the services of early detection of breast cancer toward the screening of public health (poster at ASSA 2017).