Health Care Analysis

, Volume 22, Issue 1, pp 36–58

Barriers to Reforming Healthcare: The Italian Case

Original Article

DOI: 10.1007/s10728-012-0209-0

Cite this article as:
Adinolfi, P. Health Care Anal (2014) 22: 36. doi:10.1007/s10728-012-0209-0


Using the conceptual lenses offered by the ideational and cultural path taken in the health care arena, this article attempts to explain the trajectory of recent major health care reforms in Italy and the reasons for their failure, as well as providing some directions for successful intervention. A diachronic analysis of the relatively under-investigated phenomenon of health care reforms in Italy is carried out, drawing on a systematic review of the Italian and international literature combined with the research work carried out by the Author. For all the three major health reforms examined, a significant gap between the authoritative policy choices taken and the overall implementation, in terms of process and system changes, can be observed, determining a growing distance between the theoretical efficiency and the practical effectiveness of the Italian National Health Service (NHS) as well as its detachment from the social system. The main obstacle to effective reform seems to be the cultural hegemony of the administrative-managerial and the biomedical paradigms, which, by reinforcing one another, yielded infertile ground for renewing in a post-modern sense the Italian NHS. The various Reforms have not been conceived to break such a positivistic monopoly in that they did not promote cultural or educational intervention. In this context, intervention that acts at a cultural level, such as reforming university education for physicians and managers or devising immigration policies to attract adequately acculturated people to the Italian NHS, seems to be the most promising.


Positivism Healthcare reform Universalistic healthcare system Managerialization Clinical governance Biomedical model Administrative paradigm Italy 



Evidence Based Medicine


Educazione Continua in Medicina


Diagnosis Related Groups


Italian National Institute for Statistics


General Practitioners


Local Health Unit


National Health Service


New Public Governance


New Public Management


World Health Organization

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Università degli Studi di SalernoFiscianoItaly

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