Core principles
The Italian Republic safeguards health as a fundamental right of the individual and as a collective interest, and guarantees free medical care to the indigent. No one may be obliged to undergo any given health treatment except under the provisions of the law. The law cannot under any circumstances violate the limits imposed by respect for the human person.
The founding principles are:
- Public responsibility for healthcare
- Human Dignity
- Equal access to healthcare for all citizens
- Cost-Effectiveness in the use of resources
- Public financing of healthcare through general taxation
Since the founding of the Italian NHS (SSN) in 1978 (Law 23, 833), it has undergone two major reforms: the first in the early nineties (Legislative Decree no. 502/1992 and no. 517/1993) when the Regions were granted greater responsibility and autonomy regarding health matters and the Local Health Units and Hospitals were transformed into Agencies; the second reform in the late nineties (Legislative Decree no. 112/1998 and no. 229/1999) was focused on the decentralization of health governance from the Central Government to the Regions, including the control of healthcare expenditure, and the modification of the NHS (SSN) structure and organization.
The Italian NHS is governed both at a national and a regional level. At national level, through the Central Government and the Ministry of Health, for matters regarding the fundamental health principles, set down in laws and guidelines, and the determination of the essential levels of health care, first established in 2001, which are the services that the NHS is expected to deliver to all citizens, free of charge at the point of access or upon payment of a co-pay fee (ticket) and for which the Ministry of Health is guarantor at national level. At a regional level, through the 19 Regions and the 2 autonomous provinces, as the general legislative and administrative authorities, for the establishment and organization of health structures and services. The Regions are also directly responsible for the local healthcare offer which should be specific also to territorial requirements. The Conference State-Regions unites the national and regional authorities to ensure equal rights in healthcare for all citizens.
The National Health Plan, prepared by the Ministry of Health, the Regions, the syndicates and other stakeholders, identifies the guidelines for the Italian health policy which must be approved by the Conference State-Regions