title: Diffusion and use of health technology assessment in policy making: what lessons for decentralised healthcare systems?
abstract: OBJECTIVE
  The Italian National Healthcare System (NHS) is one of the most decentralised systems since the devolution reform approved in 2001. HTA is spreading as an important tool for decision-making processes both at central and local levels. The aims of this study were to review the state of the health technology assessment (HTA) programmes in Italy - with a focus on regional and central initiatives - and to discuss consequences of a multi-level structure of HTA agencies in highly regionalised healthcare systems.
  
  
  METHODS
  Our method combined documentary review with interviews. We reviewed scientific literature about HTA's activities in decentralised systems, legislative and administrative documents from national as well as regional authorities. Semi-structured interviews were conducted with 18 key individuals associated with HTA both at the national and regional levels. Data on HTA programmes implemented or under development in nine regions were collected and analysed according to key principles for the improved conduct of health technology assessments for resource allocation decisions.
  
  
  RESULTS
  HTA is in the early stage of development in Italy, although with great heterogeneity across regions. The National Agency for Health Services has certainly contributed to HTA diffusion through supporting and training activities. However, the multi-level structure of HTA in Italy has not yet provided full coordination and harmonisation of practices and outcomes across the country, with a consequent exacerbate inequality of access to services and technologies.
  
  
  CONCLUSIONS
  There is probably need to rethink the multi-layer organizational framework of HTA in Italy by leveraging on current knowledge and efficient redistribution of activities across regions. We would advise for different jurisdictions playing different roles while achieving similar health outcomes for their patients, rather than jurisdictions aiming at doing exactly the same things resulting in unequal access to healthcare service provision.
authors.affiliation: Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, via Roentgen, 1, 20136 Milano, Italy. oriana.ciani@unibocconi.it
authors.forename: Oriana
authors.initials: O
authors.lastname: Ciani
authors.forename: Rosanna
authors.initials: R
authors.lastname: Tarricone
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Torbica
mesh_terms: D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration*; D004059:Diffusion of Innovation; D006801:Humans; D007407:Interviews as Topic; D007558:Italy; D011050:Policy Making; D011057:Politics; D012041:Regional Medical Programs / Q000458:organization & administration; D013673:Technology Assessment, Biomedical / Q000379:methods / Q000458:organization & administration*