The impact of financial deficit and decentralization of health care on public health capacities for prevention planning: an analysis of 702 projects developed by Italian Regions in their Regional Prevention Plans

Background Financial crisis and federalization of health care may have substantial impact on prevention activities in Europe. The process of decentralization of health care to Italian Regions, initiated more than 10 years ago, has led to regional discrepancies in health spending: in the period 2001-2010 a 38 billion Euros cumulative deficit was generated, mostly concentrated in a few Regions, for which the central government introduced the adoption and implementation of regional recovery plans. The aim of our study was to assess the impact of recovery plans on the regional capacities in the field of prevention planning. Methods Several multiple logistic regression models were built to analyze the impact of recovery plans on different elements of the quality of 702 projects included in the 19 Regional Prevention Plans (RPPs) 2010-2012. Projects’ quality was assessed through a specific tool developed within a Ministry of Health project to conduct an evidence-based analysis of RPPs. Models were stratified by GPD, using geographic area, overall quality of RPP and area of intervention as covariates. Results An association between recovery plans and lower levels of projects’ coherence with the regional epidemiological context (OR 0.41, 95% CI 0.25-0.70), a lack of evidence on the effectiveness (OR 0.40, 95% CI 0.19-0.85, in regions with low GDP) and cost-effectiveness (OR 0.36, 95% CI 0.19-0.67) of the interventions proposed, and a lack of consideration of sustainability (OR 0.06, 95% CI 0.02-0.16, in regions with low GDP) was found. Recovery plans led to a higher coherence of projects with regional health programming (OR 2.04, 95% CI 1.01-4.17, in regions with high GDP). Conclusions The quality of prevention projects of Italian Regions with recovery plans is lower. This may be due to weak regional management skills and public health capacities, which caused financial deficit too. By contrast, Regions with recovery plans are likely to be focused mainly on short-term issues with a high impact on health care costs (i.e. restructuring hospital care and reducing hospital stay) leaving few resources available for prevention. A different approach to financial deficit focused on long-term strategies, including those for health promotion and disease prevention, is needed. Key messages Financial deficit and decentralization of health care may have an impact on the quality of prevention planning. A different approach to financial deficit in health care focused on long term strategies and prevention activities is needed.