Overview
The health systems of high-income countries struggle with a host of common challenges involving access, quality, costs, and equity in population health outcomes. In this opening lecture for the Italian Society for Cardiology's 77th National Congress, I compare the U.S. and Italian health systems on some core measures of performance, and suggest lessons that the U.S. experience may offer Italy as it contemplates future health reforms. Fragmentation in medical care delivery and inadequate coordination among medical, public health and social service delivery are problematic characteristics of the U.S. system that Italy should be cautious to avoid. American reliance on fee-for-service payment, high out-of-pocket cost-sharing and an incomplete mix of private and public financing arrangements contribute to this fragmentation and its missed opportunities for improving population health.
