Measuring and improving quality in Italy's regionalised health system

Whilst it cannot be said that any one region delivers consistently “poor” health care, it appears that some regions struggle to provide the same quality as others. Italy has established a number of mechanisms to try and ensure an evenness of approach to quality measurement and improvement. These include activities to ensure dialogue between national and regional authorities as well as professionally led initiatives to measure quality consistently. While it would be unrealistic and undesirable to seek complete homogeneity in how regional health systems are configured, more can be done to achieve a more even approach to quality measurement and improvement across R and AP. Key priorities are to develop a more consistent approach to using information to manage performance and strengthen local accountability. Ensuring that regional resource allocation has a focus on quality, and is linked to incentives for quality improvement, will also be important. Actions that strengthen the regional approach to health care governance and delivery in Italy are also needed. Developing the responsibilities and capacities of the national authorities whose role is to support the R and AP should continue. Reframing governance as a whole such that quality improvement is emphasised as much as financial control is also necessary.