The creation of the National Health System in Italy (1961-1978)

Abstract

The Italian health system has changed its welfare model three times over the course of its 160-year existence. From a form of "residual welfare" during the liberal period (1861-1921), it became "meritocratic welfare" during the fascist period (1922-1943) and in the years of the first republic (1945-1977). Finally, in 1978, the "universalistic institutional" model of health protection was approved. For a long time, therefore, the main responsibility for citizens’ well-being was attributed to families, to the Catholic Church and its welfare networks, to entrepreneurial paternalism, and to the different health insurance institutions associated with employment sectors. Only with Law 833, which established the National Health Service (NHS), did the State recognise full and direct responsibility for citizens’ health. This paper describes the complex path that led to the establishment of the Italian NHS, highlighting the diversity of the actors involved, the multiplicity of their social and health claims, the  configuration of the public health service designed in the 1960s, and the political and social conditions that led to the effective enactment of Law 833. On the whole, it was a long, non-linear path with various barriers, where the conditions of implementation were determined by the particularity of the Italian political, economic, and social events that characterised the 1970s.