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Abstract Chapter 6

Chapter 6 explores the role of private entities that provide healthcare services on behalf of the Italian NHS (“Accredited” providers). The work focuses on four key elements: public expenditure for services provided by accredited private entities, and capacity, volumes and clinical outcomes of accredited inpatient and outpatient services. In 2015, expenditure for private accredited providers amounted to 18.8% of total NHS expenditure. This level has been stable since 2012. Private hospitals provide 30% of NHS beds. The proportion of NHS­-accredited hospital beds in private hospitals varies across regions, but has generally grown between 2007 and 2014. Accredited private providers account for 59% of outpatient facilities and 78% of nursing homes. Private hospital admissions made up roughly 26% of total NHS admissions. In the period 2009-2015, the economic value (level of reimbursement) of private inpatient admissions has been constant, while admissions to public hospitals fell about 8 percentage points. This phenomenon is partly due to the increase in the provision of services to patients from outside regional borders. An increase in the average value of admissions suggests that private providers are increasingly able to supply complex services. Finally, the chapter examines outcomes of hospital assistance, focusing on the main services tracked by the national hospital standards (D.M. 70/2015). Private providers seem to be more effective in elective surgical activities, while public providers perform better in urgent and non-elective activities. This reflects the distinct identity and institutional goal of public and private providers, emphasizing their complementarity in order to achieve NHS goals.