Sommario: 

1. Delimitazione dell’oggetto di indagine. 

2. L’istituto dell’accreditamento in Italia. 

3. Prime considerazioni sull’accreditamento delle strutture sanitarie in Italia. 

4. L’esperienza tedesca delle Krankenkassen. 

5. Erogazione privata delle prestazioni sanitarie in Germania.

6. Accreditamento “esterno” in Germania. 

7. Valutazioni di sintesi sul modello tedesco. 

8. Il modello assicurativo svizzero. 

9. Parità pubblico-privato nel settore ospedaliero svizzero. 

10. Accreditamento esterno e accreditamento esterno “qualificato” in Svizzera. 

11. Conclusioni.

Abstract:

This essay deals with the relationship between private and public initiative in health care from the specific perspective of the healthcare supply performance standards. In Italy, implementation of the so called “accreditamento” (credit) by medical corps operating within the National Health Service – that is either charged to or on account of – is not uniform among different territories. On the contrary, differentiation of supply standards has determined such a complex frame that it is not inappropriate to define even the Italian Republic as a “composite State”, where the current constitutional separation of competences between the state level and regional self governments. Starting from a comparative analysis of the healthcare credit system, the study presents the Italian experience with that of other States, which are “genetically composite”, such as Germany and Switzerland. However these National legal orders do not include an institution similar to the Italian “accreditamento” in health care, the analysis has made it possible to identify useful terms for comparison. In fact, since the half nineties, these three Countries show similar trends as the same need to reduce health care expenditure, promote competition between private and public medical institutions and, most of all, pursue of quality standards in health care supply. Comparison of different experiences particularly enlightens a very close relationship between equalization of public and private health care and the patient freedom of choice, as well as the creation of competitive markets of health care supply – however regulated – and the achievement of quality improvements. Nevertheless, the adoption of appropriate legal instruments is essential to avoid competition solely based on price.