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      The negative effect of financial constraints on planning prevention activities: some evidence from the Italian experience

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          Abstract

          This study was aimed to assess the association between regional financial deficits and Recovery Plans and the quality of the 702 projects developed by the Italian Regions within the National Prevention Plan 2010–13. Multivariate analyses showed significant associations between Recovery Plans and low quality of projects, possibly due to weak regional public health capacities. Regions with Recovery Plans are likely to focus mainly on short-term issues with a high impact on health care costs, leaving few resources available for prevention. A different approach to financial deficit focused on long-term strategies, including those for health promotion and disease prevention, is needed.

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          Cancer screening and health system resilience: keys to protecting and bolstering preventive services during a financial crisis.

          José Martín-Moreno, Ahti Anttila, Lawrence von Karsa … (2012)
          The aim of this paper is to elucidate the rationale for sustaining and expanding cost-effective, population-based screening services for breast, cervical and colorectal cancers in the context of the current financial crisis. Our objective is not only to promote optimal delivery of high-quality secondary cancer prevention services, but also to underline the importance of strengthening comprehensive cancer control, and with it, health system response to the complex care challenges posed by all chronic diseases. We focus primarily on issues surrounding planning, organisation, implementation and resources, arguing that given the growing cancer burden, policymakers have ample justification for establishing and expanding population-based programmes that are well-organised, well-resourced and well-executed. In a broader economic context of rescue packages, deficits and cutbacks to government entitlements, health professionals must intensify their advocacy for the protection of vital preventive health services by fighting for quality services with clear benefits for population health outcomes. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Bailing out expectations and public health expenditure.

            Massimo Bordignon, Gilberto Turati (2009)
            We use a "natural experiment", the fiscal adjustment of Italy in the 1990s to meet the Maastricht criteria, to test a simple model of soft budget constraint that closely resembles the intergovernmental relationships in the Italian public health care sector. We show that the link between the ex-ante financing by the Central government and the health expenditure by regions was stronger when regional expectations of future bailing outs were presumably lower. Confirming previous research, we also prove that more fiscally autonomous regions were more financially responsible and that a political "alignment" effect was present, with "friendly" regional governments controlling more expenditure than unfriendly ones. Our results suggest that, at least in Italy, bailing out expectations by regions may be the missing variable emphasised by [Culyer A.J., 1988. Health care expenditures in Canada: Myth and reality. Canadian Tax Papers, 82] for empirical models explaining health expenditure. Our results also raise some worries about the outcome of the current decentralization process in Europe.
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              Governing decentralization in health care under tough budget constraint: what can we learn from the Italian experience?

              Fabrizio Tediosi, Stefania Gabriele, Francesco Longo (2009)
              In many European countries, since the World War II, there has been a trend towards decentralization of health policy to lower levels of governments, while more recently there have been re-centralization processes. Whether re-centralization will be the new paradigm of European health policy or not is difficult to say. In the Italian National Health Service (SSN) decentralization raised two related questions that might be interesting for the international debate on decentralization in health care: (a) what sort of regulatory framework and institutional balances are required to govern decentralization in health care in a heterogeneous country under tough budget constraints? (b) how can it be ensured that the most advanced parts of the country remain committed to solidarity, supporting the weakest ones? To address these questions this article describes the recent trends in SSN funding and expenditure, it reviews the strategy adopted by the Italian government for governing the decentralization process and discusses the findings to draw policy conclusions. The main lessons emerging from this experience are that: (1) when the differences in administrative and policy skills, in socio-economic standards and social capital are wide, decentralization may lead to undesirable divergent evolution paths; (2) even in decentralized systems, the role of the Central government can be very important to contain health expenditure; (3) a strong governance of the Central government may help and not hinder the enforcement of decentralization; and (4) supporting the weakest Regions and maintaining inter-regional solidarity is hard but possible. In Italy, despite an increasing role of the Central government in steering the SSN, the pattern of regional decentralization of health sector decision making does not seem at risk. Nevertheless, the Italian case confirms the complexity of decentralization and re-centralization processes that sometimes can be paradoxically reinforcing each other.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur J Public Health
                Journal ID (iso-abbrev): Eur J Public Health
                Journal ID (publisher-id): eurpub
                Journal ID (hwp): eurpub
                Title: The European Journal of Public Health
                Publisher: Oxford University Press
                ISSN (Print): 1101-1262
                ISSN (Electronic): 1464-360X
                Publication date (Print): December 2015
                Publication date (Electronic): 09 May 2015
                Publication date PMC-release: 09 May 2015
                Volume: 25
                Issue: 6
                Pages: 1117-1119
                Affiliations
                Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 5—00185 Rome, Italy
                Author notes
                Correspondence: Paolo Villari, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy, Tel: +39 06 49914886, Fax: +39 06 49914449, e-mail: paolo.villari@ 123456uniroma1.it
                Article
                Publisher ID: ckv087
                DOI: 10.1093/eurpub/ckv087
                PMC ID: 4668326
                PubMed ID: 25958239
                SO-VID: 4c5e379c-a1e8-4b51-9bc2-03dae30b2bf6
                Copyright © © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work properly cited. For commercial re-use, please contact journals.permissions@oup.com

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                Subject: Miscellaneous

                ScienceOpen disciplines: Public health
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                ScienceOpen disciplines: Public health

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