Still too much variation in health care quality across Italian regions, says new OECD report


15/01/2015 - Italy has significantly improved the quality of health care in recent decades but needs to tackle the wide disparities that remain between regions, according to a new OECD report.


Health outcomes in Italy are amongst the best in the OECD. Life expectancy, at 82.3 years, is fifth highest in the OECD. Hospital admission rates for asthma and chronic obstructive pulmonary disease (COPD) are among the lowest in the OECD, and mortality after a stroke or heart attack are also well below OECD averages.


These reassuring figures, however, mask profound regional differences. Rates of hospital admissions for conditions like asthma and COPD, that should be avoidable with appropriate primary and community care, vary significantly. Notably, five times as many children in Sicilia are admitted to hospital with an asthma attack than in Toscana and hospital admissions for COPD vary two-fold, with 1.5 admissions per 1 000 population in Piemonte, and 3.07 in Basilicata. Rates of caesarean sections, which are associated with an increased risk of maternal death and complications and so should be limited, also show significant disparities. The national rate of caesareans in Italy is around 25%, but the rate is markedly higher in southern regions, for example Campania with a rate just over 45%, than in the Northern regions like Trentino Alto Adige (Bolzano, 13.6% and Trento 14.5%).


Efforts must be made to support weaker Regions and Autonomous Provinces to deliver consistently high quality health care. A more consolidated and ambitious approach to quality monitoring and improvement at national level is needed. A less fragmented information infrastructure would give a better understanding of health care quality. The responsibilities of national authorities whose role is to support the Regions and Autonomous Provinces, for example AGENAS, should be further developed.


While working to reduce regional variations in health care, a national emphasis on quality is needed. In recent years, fiscal pressures on the health system have been intense. While Italy delivers good health care at a relatively low cost – at USD PPP 3 027 per capita Italy spends much less than neighbouring countries such as Austria, France or Germany – slow spending growth before the crisis and spending decline in most recent years (-0.4% in both 2010 and 2011) --  have put strain on resources.


Italy must ensure that ongoing efforts to contain health spending do not subsume health care quality as a fundamental governing principle. Regional resource allocation should have a focus on quality, and be linked to incentives for quality improvement. At a regional level, quality improvement plans should be agreed with specific goals and milestones.


The OECD report also recommends that Italy:


  • Extend the health system information infrastructure, in particular expanding the range of indicators collected in the Griglia LEA (Basic Level of Asstance), and overcoming barriers in linkage across databases, particularly linking data across regions, and between regional- and national-level information systems, building on progress made under the Nuovo Sistema Informativo Sanitario, NSIS.
  • Ensure a more consistent application and reporting of national quality initiatives and minimum standards, including for primary and community care.
  • Expand community care networks and community hospitals throughout the country through the provision of financial resources, and the development of appropriate guidelines, including guidelines which address care for elderly patients, multiple morbidities, and care coordination.
  • Improve the role played by primary care providers in primary and secondary prevention.
  • Develop more ambitious forms of quality assurance and improvement for the health workforce, for example relicensing, peer-review, and physician-level quality and outcome indicators.


Journalists can find the report’s main findings and recommendations as well as the full report at


For further information about OECD’s Health Care Quality Review of Italy please contact Stefano Scarpetta (tel. + 33 1 4524 1988), Francesca Colombo (tel. + 33 1 45 24 93 60) or Ian Forde (tel. + 33 1 45 24 81 24) of the OECD’s Health Division.


OECD Reviews of Health Care Quality examine what works and what doesn’t in countries, benchmarking their efforts and providing advice on reforms to improve quality of health care. The country reviews will be followed by a final summary report on the lessons and good practices relevant to all governments.



Related Documents