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The management of antiretroviral treatments in Europe: the Italian experience

The Italian National Health Service (NHS) is composed of 21 Regional Health Services (RHS) with widely different dimensions (e.g. 9 992 548 inhabitants in Lombardy vs. 128 672 inhabitants in Valle d’Aosta in 2012 – Eurostat, Statistics online database, accessed April 2013). The role of the NHS is to address, plan priorities and monitor performances, whereas the RHS delivers services for prevention, hospital care and community care. Each RHS reimburses public and accredited private provider. They are both accredited using the same standards; each private provider is contracted for service every year for outpatient department (OPD) visits and diagnostic activities. Patient admissions are reimbursed through a diagnosis-related groups (DRG) system [1]. Each region may set its own reimbursement tariffs for OPDs and for DRGs. Prevention activities are provided by public providers, with limited use of outsourcing.