Restructuring the Italian NHS: a case study of the regional hospital network

Abstract: One of the main issues affecting the Italian NHS is the healthcare deficit: according to current agreements between the Italian State and its Regions, public funding of regional NHS is now limited to the amount of regional deficit and is subject to previous assessment of strict adherence to constraint on regional healthcare balance sheet. Many Regions with previously uncontrolled healthcare deficit have now to plan their "Piano di Rientro" (PdR) and submit it for the approval of the Italian Ministry of Economy and Finances. Those Regions that will fail to comply to deficit constraints will suffer cuts on their public NHS financing. A smart Health Planning can make sure health spending is managed appropriately. Indeed a restructuring of the Italian healthcare system has recently been enforced in order to cope for the clumsy regional healthcare balance sheets. Half of total Italian healthcare expenditure is accounted by hospital services which therefore configure as one of the main restructuring targets. This paper provides a general framework for planning a re-engineering of a hospital network. This framework is made of economic, legal and healthcare constraints. We apply the general framework to the particular case of Puglia region and explore a set of re-engineered solutions which to different extent could help solve the difficult dilemma: cutting costs without worsening the delivery of public healthcare services.