Table A1.

Governance, financing and provision in the Italian healthcare system.

Tier	Governance and Organisation	Financing	Provision
National	Ministry of Health National health plan Long term goals Essential Level of Care (LEA) Set criteria of regions financing Set criteria of ASLs funding Other functions control of industrial production agriculture environmental health standards	State-Regions Conference Distribution of available funds to regions through the National Solidarity Health Fund financed by the national value-added tax (VAT)- weighted capitation fund National earmarked corporate tax (IRAP) pooled and allocated back to the regions
Regional	Regional Department of Health Regional Health Plan: accreditation of public and private providers, monitoring quality of care, health and social care coordination, managing ASL and Azienda Ospedaliera (AOs): geographical boundaries, and appointing their directors	Regional Department of Health regional taxes became the sources of health care funding- allocation to ASL and hospital (DRG prospective payments) with national rates set by the Health Ministry Raised earmarked corporate tax (IRAP) at regional level A regional surcharge on the national income tax (addizionale IRPEF)	Independent organizations (AOs, University Hospitals and Public Research Institutes under a regional planning, financial and control scheme Delivery of care
Local	ASL Managing Boards Department Director Health Professionals	Department Directors Allocation of budget to health districts	Health Districts Public or accredited private providers under ASL control Delivery of care