The Participation of Private Clinics in the Italian National Health System

In the Italian healthcare system, private facilities can supplement public ones in delivering services within the framework of the Italian National Health System, provided they meet specific conditions and obtain the necessary authorisations. This set of requirements is known as the ‘four As’ system, comprising authorisation for the construction of the facility, authorisation to provide healthcare services, accreditation, and contractual agreements. A crucial element in this regulatory framework is the system of tariffs for the remuneration of healthcare services, which are periodically established by the Ministry of Health through a complex procedure. This model of ‘administered competition’ aims to protect both citizens’ health and fair competition among healthcare providers. Proper integration of private facilities into the National Health System is intended to enhance the effi ciency of service delivery. Th e purpose of this paper is to examine the current regulatory framework governing the participation of private clinics in the Italian National Health System and to identify any critical issues.