Il finanziamento della sanità in Italia: finanza autonoma o derivata?

Recent reforms of the National Health Service (NHS) financing system in Italy (D.Lgs. 446/97 and D.Lgs. 56/2000) have potentially given more responsibility for health care to Regions, increasing their power over this function. Starting from this normative process, the aim of the paper is to analyse the Italian health spending in the Ordinary Statute Regions (OSR), by proposing a model to verify empirically whether the financing mechanisms are actually defined at local level or if Regions act as agents of the central government. The empirical results do not support the evolution of fiscal federalism in the health sector, highlighting in fact that health financing decisions are mostly centralized in Italy, even if the institutional context has recently moved towards decentralization of health financing sources, extending the autonomy of sub-national governments.