The impact of health policy: The extreme case of Abruzzo, Italy

During the decade 2000-2010, the health-care system of the Abruzzo Region, Italy faced a financial crash and subsequent recovery. The extent of both was so large to be a case study, which may help addressing general questions including how much health-care supply can be influenced by cost-containment policies and how such strategies may impact on healthcare appropriateness/efficiency and population health status. We used data publicly available or officially provided by the Regional informatics system. The health system was deeply revised, and health reforms spanned from one-off emergency measures to structural long-term policies. From 2000 to 2005, resident's hospitalization rate increased, achieving 280 admissions × 1000 inhabitants (highest in Italy), and regional per-capita health-care debt almost tripled (+274%; E1586). From 2006 to 2010, after major health system reforms, the hospitalization rate decreased by 31.4% (with peaks as high as 74.9% for some diseases), and per-capita debt decreased by 33.0% (€E1062). Most available health-care efficiency/appropriateness indicators improved, and indexes of population health remained substantially unchanged. In extremely negative contexts, the impact of health reforms on health-care services may be impressive even in the short-run, with no or little trade-off between cost-containment and quality. The reliability of epidemiological estimates based upon hospital discharge abstract may be low when substantial variations in health policy occurred.