Containing health costs is a core concern of the central government, as public debt in Italy is among the highest in industrialized nations. Fiscal capacity varies greatly across regions. Recently, the central government imposed specific recovery plans on those regions that have generated financial deficits in health care expenditure. The plans identify tools and measures needed to achieve economic balance, which include revising hospital and diagnostic tariffs, reducing the number of hospital beds, increasing copayments for pharmaceuticals, and reducing human resources through limits on staff turnover.
In 2007, the Agency for Regional Health Services, in collaboration with the Ministry of Health, was given authority to conduct health technology assessments (HTAs) and disseminate the implementation of its findings at the regional level, but these are not yet formalized or undertaken systematically. There are very few regional health technology assessment agencies currently in place, but those that are have as their primary function to evaluate individual technologies, and the assessments are not mandatory for new or referred procedures and devices. However, reference prices for medical devices and pharmaceutical prices are set according to cost-effectiveness studies carried out by the National Committee for Medical Devices and the National Drugs Agency, respectively. Furthermore, the National Pharmaceutical Formulary bases coverage decisions in part on clinical effectiveness and cost-effectiveness. Prices for reimbursable drugs are set in negotiations between the government and the manufacturer according to the following criteria: cost-effectiveness for pharmaceuticals where no effective alternative therapies exist; comparison of the prices of alternative therapies for the same condition; costs per day compared with those of products of the same effectiveness; the financial impact on the health system; the estimated market share of the new drug; and average prices and consumption data from other European countries. Prices for nonreimbursable drugs are set by the market.