The debate on the future of the Italian healthcare system—anchored in the constitutional principle that health and healthcare should be guaranteed to all—is more relevant than ever, including in Emilia-Romagna. However, the challenge is not only about resource management or economic sustainability: it involves a radical rethinking of the very concept of health, making prevention the cornerstone of public action and healthcare organization.
**By Maurizio Morini, WHIS Italy **
A Critical Context and the Need for a New Vision
The current state of healthcare, marked by regional disparities and the difficulty of finding qualified health personnel, has resulted in a strained system—as evidenced by overcrowded emergency rooms and attempts (not always welcomed) at solutions like the CAUs (Unified Assistance Centers) in Emilia-Romagna. These facilities, designed to ease pressure on emergency rooms and bring healthcare services closer to citizens, represent an evolutionary path that deserves support and implementation, not bureaucratic obstacles or administrative resistance.
Yet, in a system increasingly driven by economic and bureaucratic logic, these efforts are now being called into question. There’s a risk of throwing the baby out with the bathwater—discarding the CAUs, which should be nurtured—due to a short-sighted vision.
A fundamental shift in perspective is urgently needed.
Stefano Zamagni, in his contribution to “Thinking Healthcare”, emphasizes the need to move beyond a “single stakeholder” governance model—currently embodied by healthcare administrations alone—towards a “multi-stakeholder” approach in which citizens are active participants, not merely passive recipients.
Back in 2016, I coordinated a study of nearly 800 Bologna residents on their views of public and private healthcare. The overwhelming demand was for higher service quality. Yet when we presented the results to the then-director of the Local Health Authority, the response was: “Service to citizens and patients is not our current priority.” That may be legitimate from a managerial standpoint, but it reveals a limited, economics-driven approach.
The Strategic Role of Prevention
A central pillar of the necessary transformation is prevention—a concept often cited, but rarely implemented in systematic, sustained ways. It is paradoxical that Italy has a robust National Prevention Plan (with the General States of Prevention event scheduled for June 16–17), developed during the pandemic, yet it struggles to be implemented—overwhelmed by the daily pressures of emergency management.
Prevention is not an abstract idea: it begins with individual behaviors—such as balanced nutrition, physical activity, and healthy lifestyles—and is expressed through public policies that support citizens from birth. Health education, starting in childhood and supported by programs for new parents, is essential for reducing the onset of chronic diseases and disorders, delivering clear human, social, and economic benefits.
Zamagni also notes that there is still no reliable quantification of the economic and social costs of mental disorders and preventable chronic diseases. Yet their widespread impact should compel radical, systemic intervention—one that removes upstream risk factors and promotes both physical and mental health.
Why not start in Emilia-Romagna and Bologna?
A Values-Based Organizational Model
Alongside prevention, rethinking the healthcare system requires a shift in organizational paradigm. Local health authorities, currently governed by purely managerial logic (often focused on cost-cutting or increasing profitable procedures like surgeries), must evolve towards models that center on values and relationships with citizens.
Milena Gabanelli, in her investigative book “Red Code”, co-authored with Simona Ravizza, highlights how the push for profit—such as through revenue-generating surgeries under the management logic of the National Health Service—risks overriding clinical evaluation and real patient health. This drift—where cost/performance ratios take precedence over quality and effectiveness—undermines healthcare’s core mission of serving people.
We need, instead, values-based management, as found in the best organizational practices: a model where the commitment to care and quality of relationships are guiding criteria, and where many doctors and nurses—if given the right conditions—will prioritize their mission and patient care over monetary compensation.
The Pillars of Necessary Change
Based on these reflections, we can outline several key points for a strategic plan oriented towards a new vision of healthcare and health:
- Prevention as the foundation: From the national plan to local policies, prevention must be the top priority, supported by health education programs starting in early childhood.
- Education and behavior: Promote healthy, informed lifestyles as an integral part of civic culture.
- Flexible and digital reorganization: Overcome bureaucracy with modular, flexible, and digital structures capable of responding to real needs—not just economic metrics.
- Balance between hospitals and local services: Strengthen community-based medicine and proximity centers to offer widespread, personalized care, building on recent efforts.
- Ongoing training: Establish dedicated structures—such as a Medical Business School—to train healthcare leaders and professionals in value-based, prevention-focused, and people-centered management. Educate citizens broadly on prevention through digital and local media campaigns.
- Citizen involvement: Shift from a top-down logic to a participatory, collaborative approach in which citizens are active agents of change.
A Complex, Unpostponable Challenge
Transforming the Italian healthcare system and building a shared culture of health is a formidable but essential challenge. It requires thinking “outside the box” to value contributions from those who observe healthcare from the outside and propose innovative, disruptive, and structural solutions.
We attempted to outline these guidelines for a holistic health management approach at the recent conference in Bologna on May 15, part of the World Health Innovation Summit. In my view, being part of an international network that develops best practices in this field is a strategic, non-negotiable choice.
Let us recognize—starting from our own region—that health is the outcome of multiple variables: lifestyle, work conditions, the environment, and relationships. Healthcare is only the final, managerial expression of these elements. That’s why we need an integrated approach that goes beyond fragmented logic and places the person—their needs and potential—at the center.
Only in this way can we guarantee truly universal, fair, and sustainable healthcare, recognizing prevention not as a luxury or a leftover option, but as the key to the health and wellbeing of all citizens—starting with us, the people of Emilia-Romagna.