Healthcare: 10 proposals for the effective implementation of the PNRR

The proposals developed by a group of researchers from six Italian universities

Ten operational proposals and three enabling factors to successfully put the PNRR's Health Mission into practice and support the SSN [National Health Service], which has been severely affected by the pandemic and which has highlighted critical points and areas for improvement. This, in brief, is the work of a group of scholars in economics, management and health policy from six universities: Università Bocconi, Politecnico di Milano, Università Cattolica, Università di Torino, Università Tor Vergata and Scuola Superiore Sant’Anna.

"The PNRR is a high-visibility document outlining an allocation of significant investment resources for the SSN that must deliver value within five years. The implementation process has just begun," stresses Francesco Longo of Bocconi University, “and it will last five years: a short time in which it is necessary to define the detailed design for each measure, build regional plans and implement policies in the individual local health authorities.”

"Interventions in the National Health Service, in addition to improving its effectiveness and efficiency, will play a decisive role in reducing inequality of access to the health system," explains Giuseppe Costa, of the University of Turin. "The success of the PNRR will also be measured by its social impact, and not only its economic impact".

The ten proposals were presented and discussed on 28 May in a webinar organised by AIES, the Italian Association of Health Economics, open to all National Health Service stakeholders. The meeting was also attended by Stefano Lorusso, Head of the Technical Secretariat of the Minister of Health.

"We have drawn up implementation proposals concerning the governance and allocation of PNRR funds," explains Federico Spandonaro of the University of Tor Vergata, "on the autonomy and constraints for the regions and their companies, on the development of the enabling factors and on the organisational and operational design of the various PNRR lines of action."

In particular, the research group identified a number of operational proposals. "Through targeted planning and continuous and timely monitoring of outcomes," says Americo Cicchetti, of Università Cattolica, "we must be able to accomplish the much-needed healthcare reform outlined in the PNRR".

The ten priority areas of intervention identified by the research team are:

  • strengthening General Medicine and developing its infrastructure
  • enhancing the provision of care for chronic conditions
  • streamlining the local outpatient network
  • ensuring self-sufficiency at home in an integrated way with the welfare system
  • standardising the equipment of intermediate structures between regions
  • planning and implementing a change in the skill mix of doctors and health professions
  • reforming the public health system by adopting a 'one health' approach to health
  • promoting clinical expertise in the small hospital network
  • renovating the infrastructure of large hospitals by switching their logistics and increasing their flexibility and sustainability
  • modernising the technology stock of hospitals and making them more efficient

"The role of the Regions will be fundamental in the implementation of the PNRR," explains Milena Vainieri, of the Scuola Superiore Sant'Anna. "This is why it is crucial to implement a Technical Support Instrument on the model of the Next Generation EU to support the design and implementation of reforms in the Member States. In other words, a fund must be made available to the regions to acquire skills for all phases of the projects.

However, the future of the NHS also depends on the grounding of three strategic enablers: research and innovation, digital transformation and capacity building. "However, success cannot be taken for granted," says Cristina Masella of the Politecnico di Milano, "as it requires a great deal of cohesion of purpose, to be achieved through a strong focus on creating convergence and institutional cooperation: our work aims precisely at facilitating a continuous dialogue between all parties."

The members of the working group

Eugenio Anessi Pessina (Università Cattolica), Amelia Compagni (Università Bocconi), Giuseppe Costa (Università di Torino), Americo Cicchetti (Università Cattolica), Giovanni Fattore (Università Bocconi), Francesco Longo (Università Bocconi), Cristina Masella (Politecnico di Milano), Sabina Nuti (Scuola Superiore Sant’Anna), Federico Spandonaro (Università Tor Vergata), Daniela D’Angela (Università Tor Vergata), Barbara Polistena (Università Tor Vergata), Milena Vainieri (Scuola Superiore Sant’Anna), Federico Vola (Scuola Superiore Sant’Anna), Michela Bobini (Università Bocconi), Francesca Meda (Università Bocconi), Claudio Buongiorno Sottoriva (Università Bocconi).