The 2022 community-based integrated care reform in Italy: From desiderata to implementation.

The Italian National Recovery and Resilience Plan allocated € 7 Bn for community care. In May 2022, the Italian government issued a Decree to define the strategy for the development of community-based integrated care. The reform aims to create uniformly a network of services close to where patients live, thus overcoming geographical disparities between regions. The strategy is based on a strong role of the central government in community care, but still leaves autonomy to regions. Levelling availability of services across territories, setting uniform targets with a short period horizon and disregarding starting points may create important implementation problems. Financial constraints will also hamper the implementation of the reform. Ultimately the development of Italian community care will depend on the institutional and managerial capabilities of regions and local health authorities. Firstly, they should shape the actual implementation of community care services by defining organizational arrangements, priority targets and models of care delivery. Secondly, they should develop strategies to face the lack of financial resources and the shortage of healthcare workforce. This contribution informs international readers about a major policy in a European country and its implementation challenges. It offers insights into inter-government relations in NHS-type healthcare systems (Nordic countries and Spain), showcasing the complexity of policymaking involving multiple political actors and resulting indeterminacy of policies and their implementation.

Therapeutic innovation in high-prevalence chronic diseases: Challenges and opportunities for specialist care models.

Therapeutic innovation is expected to change if not disrupt present care models for several chronic diseases in the coming years, as suggested by recent clinical trials. New drugs that anticipate and possibly delay the full expression of a disease will likely face some common challenges, such as the need of designing and implementing large scale interventions; the necessary engagement of multiple specialties for both diagnosis and treatment; the shift from specialist to non-specialist interventions and secondary prevention. Building on the case of HCV and other innovation in hepatology, we discuss common challenges caused by disruptive change that other chronic conditions faced in the past. The recent history of hepatology shows interesting examples of disruptive innovations that completely reverted traditional treatment approaches. As we learned from the slow early diffusion of antiviral drugs, without a clear information and a prompt design of the appropriate delivery modalities, the effectiveness of new treatments is undermined and care risk to be postponed for long time. This implies the definition of (i) new service models diversified by care phases and patients' target; (ii) horizontal integration: to go beyond the professional boundaries to build solid alliances; (iii) vertical integration between primary and secondary care.