# Local Health Authority (Italy)

A Local Health Authority (Italian:azienda sanitaria locale), commonly abbreviated as ASL in Italian, or a Local Health Unit Authority, known as AUSL, is a public organization that falls under the purview of the Italian public administration. Its primary mandate is to deliver healthcare services to a specific territorial area, which is typically at the provincial level. In different regions of Italy, these entities are referred to by various designations, including ASP, ASM, ATS, and AST.
The primary responsibility of a Local Health Authority in Italy is to perform the tasks of the National Health Service, as well as other duties established by law within the specified territorial area.

## History

Health services in Italy were initially managed by casse mutualistiche (mutual funds) dating back to the establishment of INAM in 1943, which was officially recognized by the Italian Republic in 1947. These mutual funds provided unequal treatment to workers and the unemployed or underemployed.
However, with the passage of the National Health Service law on 23 December 1978, known as Law No. 833, the provision of health services became the complete responsibility of the state. The services were provided across the country in accordance with the provisions of Article 32 of the Italian Constitution. The law also established the Unità Sanitarie Locali (USL) (Local Health Units) as the primary providers of healthcare services.
Later on, Legislative Decree No. 502 of 30 December 1992 transformed the Local Health Units into Local Health Authorities that were granted autonomy and were no longer centrally organized at the national level. Instead, they were under the authority of the Italian regions.

## Description

Local Health Authorities are integral components of the national health service and are public companies with legal personality. They possess organizational, managerial, technical, administrative, financial, and accounting autonomy, functioning as centres for entrepreneurial activities. In fact, as per Article 3 of Legislative Decree No. 502, issued on 30 December 1992, "for the pursuit of their institutional objectives, Local Health Authorities are established as companies with public legal personality and entrepreneurial autonomy".
Based on the explicit meaning of this provision, they can be considered as economic public bodies. However, since the beginning of 1993, according to prevailing jurisprudence, Local Health Authorities have been regarded as entities under the jurisdiction of the Italian regions. They possess their own legal personality and autonomy, which has subsequently acquired an entrepreneurial character as well.

## Denominations

Each Italian region chooses its own denomination for the Local Health Authority.
In Liguria, Abruzzo, Campania, Lazio, Piemonte, and Puglia, they are called Azienda Sanitaria Locale – ASL (Local Health Authority).
However, they have different designations in the following regions and autonomous provinces:
* Alto Adige: South Tyrolean Health Authority (Azienda Sanitaria dell'Alto Adige – ASDAA) or Südtiroler Sanitätsbetrieb (SABES) (in German).
* Basilicata: Local Health Authority of Matera (Azienda Sanitaria Locale di Matera – ASM) and Local Health Authority of Potenza (Azienda Sanitaria Locale di Potenza – ASP).
* Calabria: Provincial Health Authority (Azienda Sanitaria Provinciale – ASP).
* Emilia-Romagna: Local Health Unit Authority (Azienda Unità Sanitaria Locale – AUSL).
* Friuli-Venezia Giulia: University Health Authority (Azienda Sanitaria Universitaria – ASU) and Health Authority (Azienda Sanitaria – AS).
* Lombardia: Health Protection Agency (Agenzia di Tutela della Salute – ATS).
* Marche: Territorial Health Authority (Azienda Sanitaria Territoriale – AST).
* Molise: Regional Health Authority of Molise (Azienda Sanitaria Regionale del Molise – ASReM).
* Sardegna: Regional Health Authority (Azienda regionale della salute – ARES).
* Sicilia: Provincial Health Authority (Azienda Sanitaria Provinciale – ASP).
* Toscana: Local Health Unit Authority (Azienda Unità Sanitaria Locale – AUSL); AUSL Toscana Sud Est (Tse); AUSL Toscana Centro (Tc); AUSL Toscana Nord Ovest (Tno).
* Trentino: Provincial Authority for Health Services (Azienda Provinciale per i Servizi Sanitari – APSS).
* Umbria: Local Health Unit Authority (Azienda Unità Sanitaria Locale – USL).
* Valle d'Aosta: Local Health Unit Authority (Azienda Unità Sanitaria Locale – AUSL) or Unité sanitaire locale – USL (in French).
* Veneto: Company – Socio-Health Local Authority (Azienda – Unità Locale Socio Sanitaria – AULSS).