Giovanna Morelli Federico Spandonaro

Personal Care Services in Health Economics: On the Efficiency-Equity Trade-Off

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The paper focuses on the recent evolution in performance of healthcare production in Italy. It regards the technical efficiency and equity in the use of public funds in public primary healthcare actions, concerning the funding profile in the new scenario of fiscal federalism. The analysis is directly concerned with the degree of utilisation of public resources and the production efficiency of the healthcare services provided. On a theoretical basis, healthcare services might be considered as merit goods, since they are granted directly at a first-aid level by the State on the provision of the Italian Constitution Act. At article 32, health is recognized as a fundamental right of the individual and as a collective interest; equity and equal access to all citizens are ensured. Nevertheless, this scenario may drive to a detriment of competition, to a failure in the market and to allocative inefficiencies. For the future, the growing financial responsibilities of the Italian Regions in this respect might give a solution, in which direction, at the moment, it is difficult to predict. The paper analyzes the potential impacts of decentralization reform in the healthcare sector using the technical efficiency as a parameter of evaluation of its performance; the idea is to verify possible associations among technical efficiency, equity and the funding profile of expenses with healthcare.


  • healthcare production
  • equity
  • efficiency
  • fiscal federalism
  • Italy


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