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The Italian health system has changed its welfare model three times over the course of its 160-year existence. From a form of «residual welfare» during the liberal period (1861-1921), it became «meritocratic welfare» during the fascist period (1922-1943) and in the years of the first republic (1945-1977). Finally, in 1978, the «universalistic institutional» model of health protection was approved. For a long time, therefore, the main responsibility for citi- zens' well-being was attributed to families, to the Catholic Church and its welfare networks, to entrepreneurial paternalism, and to the different health insurance institutions associated with employment sectors. Only with Law 833, which established the National Health Service (NHS), did the State recognise full and direct responsibility for citizens' health. This paper describes the complex path that led to the establishment of the Italian NHS, highlighting the diversity of the actors involved, the multiplicity of their social and health claims, the configuration of the public health service designed in the 1960s, and the political and social conditions that led to the effective enactment of Law 833. On the whole, it was a long, non-linear path with various barriers, where the conditions of implementation were determined by the particularity of the Italian political, economic, and social events that characterised the 1970s. [ABSTRACT FROM AUTHOR]

After reviewing the historical background and foundation of the British, Italian, German, Swiss and French, this paper discusses how – structural rather than policy – reforms have changed the organization of the delivery of primary care and how the role of private insurers differs across the selected countries.Journal of Medical Marketing (2009) 9, 96–103; doi:10.1057/jmm.2009.6; published online 5 June 2009 [ABSTRACT FROM AUTHOR]

Starting from an extensive database, pooling 9 years of data from the top three insurance brokers in Italy, and containing 38125 reported claims due to alleged cases of medical malpractice, we use an inhomogeneous Poisson process to model the number of medical malpractice claims in Italy. The intensity of the process is allowed to vary over time, and it depends on a set of covariates, like the size of the hospital, the medical department and the complexity of the medical operations performed. We choose the combination medical department by hospital as the unit of analysis. Together with the number of claims, we also model the associated amounts paid by insurance companies, using a two-stage regression model. In particular, we use logistic regression for the probability that a claim is closed with a zero payment, whereas, conditionally on the fact that an amount is strictly positive, we make use of lognormal regression to model it as a function of several covariates. The model produces estimates and forecasts that are relevant to both insurance companies and hospitals, for quality assurance, service improvement and cost reduction. [ABSTRACT FROM AUTHOR]

This paper examines the right to health care. Various expressions of this right may be distinguished. These include both individual rights and social rights which could be based upon international treaties and constitutional rights. They may be found in national health legislation and, in some cases, in jurisprudence. To analyze the consequences of limiting the right to health care, a framework for judicial review has been developed which encompasses these expressions of the right to health care. The framework was used to examine legal and health policy developments in three Western and two Eastern European countries. In Italy and the Netherlands the right to health care is protected constitutionally (but on differing legal bases) while the United Kingdom does not have a written constitution. In contrast, Hungary and Poland have for many years seen the state take responsible for the provision, administration and allocation of health care services and the right to health care was guaranteed theoretically but not in practice because of the lack of (financial) means. However, the Polish Constitution explicitly anticipates possible limitations of the right to health care. What all these countries have in common is a cost containment perspective where the future will bring even tighter limits on what resources patients may consume. Despite differences in legal structure between these countries, where they seem to converge is on the consequences of putting limitations on the right to health care. The courts in Italy, the Netherlands and the UK have formulated conditions drawn from the acceptance that this right has to be judged within the context of limited resources. It may be concluded that finding a compromise between the right to health care and cost containment policies could also be an issue, Eastern European countries will have to face in the future. [ABSTRACT FROM AUTHOR]

This work investigates the determinants of health care expenditures, such as drug prescriptions, inpatient care, and outpatient care, of the resident population of the Region of Friuli Venezia Giulia (Italy). The phenomenon of interest is examined here by considering a cross-sectional register-based dataset on individual expenditures exhibiting a cross-classified hierarchical structure. In fact, patients (about 1,000,000) are grouped by general practitioners and municipalities. Does the evidence in individual data analyses support the results of the micro- and macroeconomic literature? The adoption of disaggregated data allows us to disentangle the role of the micro- and macroeconomic determinants of the expenditures. Moreover, the degree of interdependence between neighbouring municipalities is measured by accounting for the spatial correlation in the error convolution. A feasible two-stage Heckit method has to be adapted to encompass the zero-inflation issue, to consider the hierarchical structure of data and to study the spatial diffusion process of the expenditures in the sample selection model framework. The main results on the determinants of health care expenditures at the macro-level are confirmed in our analysis on disaggregated data. On the contrary, however, the substitution effect, which is typically observed in aggregated data, has not been confirmed by the present research. Moreover, the selection process appears to be relevant in drug prescriptions and outpatient care expenditures and a significant spatial correlation in both the selection and the outcome equations emerges from the structure of error components. [ABSTRACT FROM AUTHOR]

This article focuses on the main health reforms enacted in Italy over the past one hundred years. Such reforms were all undertaken in conjunction with a severe political and institutional crisis. The 1943 reform was approved a few weeks before the fall of the Fascist regime. The National Health Service, established by Law No. 833 of 1978 and enacted during one of the most turbulent times in the history of the country, represented the apex of the brief experience of the "national solidarity" governments. Even the 1992-93 reform was put into effect in the midst of the Tangentopoli scandal, which marked the transition from the First Republic to the so-called Second Republic. To attempt an analysis of the main turning points in Italian health care policies, the well-known multiple streams approach is adopted. [ABSTRACT FROM AUTHOR]

Objective: Antiparkinsonian pharmacotherapy is costly and the determinants of drug costs in Parkinson's disease (PD) have been poorly investigated. The objective of this study was to investigate the costs of PD and antiparkinsonian drugs in an Italian cohort of patients and identify cost-driving factors of drug therapy. Methods: Seventy outpatients with idiopathic PD were recruited in the Department of Neurology, Napoli University, Italy. Data on resource utilization were collected for 6 months using a bottom-up approach. Clinical status was evaluated using the Unified Parkinson's Disease Rating Scale. Direct and indirect costs were calculated from the societal perspective (figures of year 2009). Independent determinants of total costs and costs of antiparkinsonian drugs were identified using multivariate regression analysis. Results: The total costs of PD were EUR 8,640 (95% CI: EUR 6,700-11,240) per patient over a 6-month period. Direct costs accounted for 70% of the total costs. Antiparkinsonian drugs (EUR 1,450; 95% CI: EUR 1,220-1,760) were the primary component of costs paid by the health insurance (39.6%) and one of the most expensive components of the direct costs (24.0%). The highest copayments made by patients were for antiparkinsonian drugs and medical equipment (58%). Independent determinants of the increased costs of antiparkinsonian pharmacotherapy were younger age and occurrence of motor fluctuations. Conclusions: Antiparkinsonian pharmacotherapy is one of the major cost components of PD-related costs for health insurance. It imposes a considerable economic burden on patients and their families as well. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The UK's National Health Service is approaching its sixtieth anniversary, an oppportune time perhaps to consider the case of the United States, where there is no national health service. Federal law requires hospitals to treat those who enter their emergency rooms, but not for free; military veterans are offered care in health facilities supported by federal tax dollars and the national Medicare programme provides government-sponsored health insurance for specified services to those over 65 years of age and to individuals certified as disabled. However, Medicare does not provide health services, which are predominantly purchased in the private sector. This article considers the history of American health care over the past 60 years, reflecting the diverse ways in which health care is embedded in the economy, politics, power structures and culture of the United States and discussing what it is like to have a health care industry without having a national health service or universal health insurance. The article concludes that, since the Second World War, the United States has been successful in achieving highly specialized, valued, life-improving health care for most--not for all--members of the population, but at a huge and rising cost. Notable achievements have been produced by the public-private mix of the American health enterprise. However, broad questions of social class, illness, insurance and the burden of payment for health care remain in a society with widening divisions of the population by socio-economic class, education, health literacy and computer skills. [ABSTRACT FROM AUTHOR]

The article presents abstracts of medical studies. They include "Trends in Educational Inequalities in Smoking Cessation Rates in Italy 1980-2000," by Bruno Federico and colleagues, "Preventive Health Care Utilization Among the Unemployed: Evidence from Croatia," by Zvonko Sosic and colleagues, and "Access to Medical Services of Vulnerable or Pauperized Persons That Do Not Hold Medical Insurance," by Ala Nemerenco.

Here, we report regarding the health status and medical support for patients suffering from endometrioisis in South Tyrol, which is a politically autonomous province in the north of Italy containing three different ethnic groups. The health service is administered largely by the autonomous regional government. Because of the establishment of a centre for reproductive medicine and the introduction of laparoscopy as a prime surgery method, the gynaecological department of the hospital in Bruneck developed into a reference centre for diagnosis and surgical treatment for endometriosis. The planned future social, health care and insurance developments on local and national level regarding this illness will be discussed. [ABSTRACT FROM AUTHOR]

Background: Medical malpractice is an important topic worldwide, and orthopedics is a clinical branch that is considered to be at a high risk for claims. The analysis of a series of medmal insurance claims allows forensic pathologists, clinicians, and insurance companies to probe the risk of a specific clinical branch for medical malpractice claims and highlights areas where care may be improved. We investigated the main features of a major Italian insurance broker's archive in order to identify recurrent pitfalls in this field.Materials and Methods: A retrospective study was carried out on orthopedics claims. The archive covered claims from 2002 to 2013 that targeted 1980 orthopedists.Results: 635 claims were found and analyzed with a focus on the clinical activity invocked in the claim, the presence of alleged team malpractice, the clinical outcome of the case, and the final forensic decision regarding the claim. 299 orthopedists had at least one malpractice claim made against them during the available period; 146 orthopedists were subject to more than one malpractice claim. Most of the claims regarded perioperative and operative cases, usually originating from civil litigation. The anatomical sites most commonly involved were the hip or knees, and sciatic nerve lesions were the main contributor.Conclusions: Orthopedics is a medical specialty with a high risk for malpractice claims. In our study, medical malpractice was observed in nearly 50% of the cases-typically in surgery-linked cases resulting in permanent impairment of the patient. Death from orthopedics malpractice seemed to be rare.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]