Between Public and Private: The Business History of Hospitals in Italy (1968–2018)

The chapter explores the transformations of the Italian hospital system in the period 1968–2018. Focusing on how the changing institutional framework has affected hospitals strategies and management, it aims to analyze the complexities of a system based on the coexistence/competition of public and private healthcare providers. To overcome the inefficiencies and inequalities generated by the great fragmentation inherited from the past, the reforms of the 1960s and 1970s set up a process of modernization and standardization which led to the establishment of the National Health Service (1978). However, in the 1990s a radical reform changed the system again, promoting a process of corporatization, regionalization, and liberalization, and designing a competitive framework for both public and private hospitals. In the twenty-first century, in a context marked by cuts in public health spending and major demographic and social changes, the Italian health system presents a relevant growth of private providers and a visible fragmentation at a regional level.