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Summary: Italy

Italy has a national health service (Servizio Sanitario Nazionale; SSN) that is moving towards decentralisation and empowerment of local health enterprises (LHEs) - the arms of the regions for delivering health services. Drug policy and spending decisions are both influenced by central government and local authorities.

At a macro level, the government holds the power to decide the amount of drug expenditure (currently at 13.80% of total SSN expenditure, one of the lowest in Europe), pricing policy, price negotiation, reference price and price cuts, co-payments, criteria for reimbursement and inclusion in the positive list.

At the micro level, however, the LHEs are beginning to foster a better use of drugs by general practitioners. One of the tools employed is local voluntary agreements between LHEs and general practitioners (GPs) that may be supported by economic incentives, in cash or in kind.

During the last three years, the government has adopted nine different laws and decrees affecting pharmaceuticals. These changes have reversed a trend towards a more market-driven environment.