7.2 Administration and governance
In Italy, the governance of the health system is a concurrent matter between the State and the Regions. The Constitution reserves to the State’s exclusive competence the determination of the essential levels of benefits concerning any civil and social rights that must be guaranteed on the national territory (Article 117, paragraph 2, letter M), international prophylaxis (Article 117, c.2, letter q), the determination of the fundamental principles in matters of shared competence, including health protection and scientific research. The Italian health service is based on the principles of uniformity of the levels of assistance across the territory, equity of access to services for all citizens and financial solidarity. The aforementioned principles are implemented through the provision of services and services included in the Essential Levels of Assistance (LEA), namely the benefits and services that the National Health Service is required to provide to all citizens through public resources, for free or upon payment of a participation fee (ticket). The LEAs were established with the Decree of the President of the Council of Ministers (DPCM) of November 29, 2001 and the Decree of the President of the Council of Ministers (DPCM) of January 12, 2017 updated the new essential levels of assistance. The Prime Minister’s Decree identifies three major Levels:
Collective prevention and public health, which includes all prevention activities aimed at both the community and individuals; in particular:
- Surveillance, prevention and control of infectious and parasitic diseases, including vaccination programs;
- Protection of both health and safety of open and confined environments;
- Surveillance, prevention and protection of health and safety in the workplace;
- Animal health and veterinary urban hygiene;
- Food safety - consumer health protection;
- Surveillance and prevention of chronic diseases, including the promotion of healthy lifestyles and organized screening programs; nutritional surveillance and prevention.
- Medical-legal activities for public purposes.
District assistance, namely the health and sociomedical activities and services throughout the territory, articulated as follows:
- Primary health care;
- Territorial health emergency;
- Pharmaceutical assistance;
- Supplementary assistance;
- Outpatient specialist assistance;
- Prosthetic assistance;
- Thermal/SPA assistance;
- Home and local social and health care;
- Residential and semi-residential social and health care;
Hospital assistance, articulated in the following activities:
- First aid;
- Ordinary hospitalization for acute cases;
- Day surgery;
- Day hospital;
- Post-acute rehabilitation and long-term care;
- Transfusion activities;
- Transplantation of cells, organs and tissues;
- Poison control centres.
The performance and services included in the LEA are provided uniformly throughout the national territory. The main state actors, through which Italy operates in the field of population health and which also intervene in the field of health and well-being of young people are the Ministry of Health and several other Ministries that have responsibilities in this sector:
Ministry of Health: structured in 4 departments, it is the central body of the National Health Service to which are assigned the functions pertaining to the State in terms of human health protection, coordination of the National Health System, veterinary health, health protection in the workplace, hygiene and food safety. It arranges the National Health Plan and represents the connecting element between the WHO (OMS) and the European Medicines Agency (MEA).
Various Commissions and Advisory Committees are headquartered in the Ministry of Health, including the Joint Group for the implementation of the “Gaining Health” program (Cf. paragraph 7.4), which draws particular attention to the health and well-being of young people.
Local authorities and bodies
Regions and Autonomous Provinces: The Constitution (art. 117) gives the Regions competence in matters of the planning and organization of health and social services (art. 117, c. 4). The Regions can legislate in compliance with the fundamental principles of state legislation and have exclusive competence in the organization of services and activities aimed at health protection. They can also deliver services in addition to those included in the LEA, using their own resources.
Among the matters falling within the exclusive competence of the Regions, there are also the financing criteria of local health authorities and hospitals.
Local health authorities (abbreviated ASL or AUSL): these are public bodies responsible for providing health services. The ASLs are part of the national health service; they are companies with a public personality, with organizational, managerial, technical, administrative, patrimonial and accounting autonomy. Each Local Health Unit is organized into the following complex technical-functional structures: hospital garrison; hospital district; health district; departments.
ISS (Istituto Superiore di Sanità): technical-scientific body of the National Health Service, placed under the supervision of the Ministry of Health, which carries out research, experimentation, control, consultancy, documentation and training on public health;
Council for Agricultural Research and Agricultural Economy Analysis (CREA): a national body supervised by the Ministry of Agricultural, Food and Forestry Policies (MiPAAF) which aims to increase the international and national competitiveness of Italian agricultural, food and agro-industrial enterprises as well as improve the safety, quality, economic, social and environmental sustainability of the agricultural, livestock and forestry sectors. CREA also carries out institutional research activities, requested by MiPAAF and other public administrations, as a support for knowledge for the planning of sectorial policies. This involves the collection and analysis of statistical data, drafting of documents for the definition of policies and certification activities.
National Agency for Regional Health Services (AGENAS): a national non-economic public body that provides technical and operational support to the government policies of the State and Regional Health Services through research, monitoring, evaluation, training and innovation activities;
National Institute for Accidents on the Workplace (INAIL): subject to the supervision of the Ministry of Labour and Social Policies, it carries out activities of accident prevention, research and rehabilitation and reintegration of injured workers, also through its prosthesis centre. INAIL also promotes the adoption of measures to promote health and safety in the workplace, including the adoption of safety management systems, including the ISI tenders (Incentivi di Sostegno alle Imprese);
Scientific Hospitalization and Care Institutes (IRCCS): hospitals of excellence, subject to the supervision of the Ministry of Health, which pursue research purposes, mainly clinical and translational, in the biomedical field as well as in the organization and management of health services. They also carry out high specialty hospitalization and care services as well as other activities of excellence.
Thanks to the close cooperation between the Ministry of Health and the Ministry of Education, University and Research, it was possible to witness a change that has allowed for the consolidation of health promotion as a process whose responsibility is no longer to be considered exclusive to the health sector, in line with the main international guidelines as well as with national regulations and documents. At a territorial level, although some experiences have been consolidated over the years, the relationship between the school system and the health system requires greater interaction, aimed at integrating specific skills and purposes.
Other ministries are involved in a series of programs, initiatives and projects to promote and support the health and well-being of young people:
- Ministry of Agricultural, Food and Forestry Policies;
- Ministry of Education and Ministry of University and Research;
- Ministry of Economic Development;
- Ministry of Economy and Finance;
- Ministry of the Environment;
- Ministry of Labor and Social Policies;
- Department for the Sport of the Presidency of the Council of Ministers.
The CONI (National Olympic Committee) is responsible for promoting motor, physical and sports activities as well as for spreading an increased awareness and culture of movement among the entire population, with particular attention to the youngest, starting from the school environment, through sports opportunities, along with specific and targeted training interventions.