Domain 3: Workforce 23

1. Introduction

The COVID-19 pandemic has undoubtedly been the most significant shock that the Italian National Health Service (NHS) has had to face since its establishment in 1978. Up to December 31 2020, more than 74,000 people had died, and more than 2 million people had been infected with the virus that causes COVID-19— SARS-COV-2. This pandemic has provided significant insight into the future sustainability and resilience of the Italian health system.

As part of the Partnership for Global Health Resilience and Sustainability (PHSSR), this report uses COVID19 as a critical event to evaluate the sustainability and resilience of the health system in Italy according to five key domains:

§ Governance § Health System Financing § Workforce § Medicines and Technology § Service Delivery

Findings: key themes for sustainability and resilience

The COVID-19 health emergency represents a rare opportunity to analyse key strengths and weakness of our healthcare systems. Although further detail will be provided in the following pages, Table 1 reports some key issues determined from our analysis.

Table 1: Summary of key findings

Domains

Sustainability Key findings

Resilience

Governance § Regional devolution in healthcare has made regions accountable for healthcare, but central–regional relations are still unclear and often conflictual. This situation has made differences more profound region-toregion in terms of structure, processes and outcomes. § The initial coordination by the central level has produced some protocols, guidelines, instructions and tools for regional healthcare systems in responding to the COVID-19 pandemic. Nevertheless, regions have attempted to use their full competencies on healthcare, producing different response models with varying outcomes.

Health system financing

§ The centrality of hospitals in the healthcare delivery system is preventing the full integration of care among different levels (primary, secondary, tertiary).

§ The funding allocation mechanism does not consider social deprivation, education, employability or housing and family conditions. § Since 2011, the NHS budget has grown less than the EU average, below inflation, and is not in line with growing healthcare needs. This

§ The initial response at the central and regional levels could have been faster and better coordinated if an up-to-date version of the pandemic plan was available (latest revision 2006)