Institutional accreditation of Health Services in Italy: the long road to quality.

The term “accreditation” was introduced in Italian health legislation in the early ‘90s, with the adoption of decrees 502/1992 e 517/19931. The concept added a new element to the authorisation system defined in Law n. 833, that had established the Italian National Health Service (SSN) in 1978. It has developed over time into an institutional recognition, issued by the Public Authority, that is a statutory requirement for any entity providing services as part of the SSN. It aims to achieve a high level of guarantee of service quality and of the selection of service providers, public and private, that work as part of, or on behalf of, the SSN. Specifically, the National Health Plan 1998–2000 identified the accreditation as one of instruments for ensuring quality of healthcare in that it “responds to the need for a process of provider selection that applies healthcare quality criteria”, thus clearly identifying their essential aims and characteristics. The implementation of this policy was slow and difficult, not only because of the strength of economic interests associated with healthcare activity and the birth of federalism in healthcare provision, but also because of a widespread culture that tends to give more importance to the work of the individual healthcare professional than to achieving a well-integrated and co-ordinated system as a whole, with attention to, and demonstration of, transparency in terms of inputs (resources) and outputs (processes, results and outcomes).