Abstract

Over the last fifteen years, Italy has been developing an ambitious program aimed at defining a benefit catalogue for health services to be provided to all citizens ("Livelli Essenziali di Assistenza" - LEA). This national healthcare initiative is based on a combination of criteria ranging from human dignity to effectiveness, appropriateness and (allocative) efficiency and was part of a broader strategy to change the balance of powers between the State and the regions, otherwise known as «healthcare federalism». Within this context the Italian National Health Service must guarantee that Italian citizens receive the benefits they are entitled to in their Region of residence, while Regions remain responsible for all administrative and organizational matters concerning the actual provision of relevant services. LEA therefore assume a dual role both as an explicit benefit catalogue which defines citizens' health rights and an essential element in the relationship between the central government and the Regions. At a distance, the dream of the late '90s proved a mirage which recently ended up in a nightmare. Political vagaries and austerity policies which severely hit the Italian NHS transformed the LEA into a policy tool primarily devised to keep the Regions under tight financial control by the national government, thereby distancing their current profile from the original design.