Abstract
Autore:
Rampulla Francesco Ciro
Titolo:
"Pubblico e privato: dall´evoluzione all´involuzione della disciplina nazionale delle prestazioni ospedaliere"
The transformation of public hospitals into companies began with the Mariotti law, which reformed hospital organizations, although very soon that reform was superceded by the transfer of responsibility for the health service to the regional authorities (le Regioni).
Law 833/78 began a phase in which all aspects of the health authorities (USL), and the system of remuneration was il piè di lista (i.e., a system whereby losses are covered by the state) in the case of the public sector, while in the private sector the system was one of rette di degenza convenzionate (i.e., a system whereby USL pay patients pre-established fees).
The situation changed again as a result of the so-called decreti di riordino (reorganization laws), which introduced payments on objective bases for public and private hospital structures and a uniform system of remuneration according to treatment. But with the budgets of 1994 and 1998, and the secondary laws that followed, variations were introduced in the system of payments, in order to allow for programming, and in the mechanism of remuneration, which was partially changed from that based on treatment to one based on functions, following both the qualiquantitative model of programming treatment and successive agreements.
It is fanciful to speak of a public-private market for treatment or of a regulated market for treatment, since there is a barrier to entry, there is a program which determines amounts of treatment, and there are agreements between the regional authorities that is the local health authorities (ASL) and the relevant actors in the sector.
