Starting down the road to targets in health: the case of Italy

Abstract

Italy adopted a health targets strategy in 1998 covering five key areas of population health and involving 100 targets. It has already become clear that how the health targets are ‘managed’ will be crucial to the strategy's success. Italy has a national health service but also has a regional system of government. The regions already possess considerable legislative, administrative and regulatory power and government policy is to grant them even more autonomy in the coming years. Implementation of national health targets requires cooperation both within the regions and between them and the central government given that the former are free to select those national health targets which they consider best suited to their planning priorities. The Ministry of Health set up a 3 year programme aimed at accelerating regional involvement in health target setting and implementation. The majority of projects submitted for funding by the regions have had difficulty meeting the programme's eligibility criteria. Some regions seem to lack a clear understanding of the health targets approach, a good number of the national targets may be of limited interest for regional health policy and the national time frame may be unacceptably long for regional policy makers. Even at this early stage, it is evident that managing national health targets in a decentralised system of government is a complex business where decisions are the outcome of negotiation and compromise.