The Italian Healthcare

1
The Italian Healthcare

• December 2004 Health Valley
• Laetitia Poulenard
• ToSca International
• Nîmes, France

2
Summary

• Overview
• Health expenditure
• Introduction
• Organizational Structure
• Healthcare financing
• Healthcare delivery system
• Pharmaceuticals and healthcare technology
• Conclusion

3
Overview

• The italian healthcare system had two majors
  changes since the established model of NHS in
  1978, in 1990 a real decentralization of the
  services, in 2000 with patient partner attitude
• Italian healthcare accounts for 9 of GDP in
  2000., Italy is the EU average

4
HEALTH EXPENDITURE

• Italy is in EU a unique model of population with
  the lowest fertility rate in the world 1.19
  child/ women, and has the highest ratio of older
  to younger people, together with a long life
  expetancy about 81.2 years old for women.
• A Federalist state of Healthcare, each region are
  in charge of their health structure and the
  state has only a steering role
• In 2002 the government introduce the Private
  Sector to the Italian and tend to reach 50-50
  system.

5
Organizational Structure

• Italy is organised at three level, central,
  regional and local
• NHS target from national plan
• Regional level to assess quality and efficiency
  of Local USSL
• Local USSL to assess need and provide local care
• In 1999 State introduced a fourth body Private
  sector (called Private accredited providers),
  with managerial delegation
• Citizens of Italy now have for 35 a private
  insurance to cover those private costs.

6
Healthcare financing

• The tax based system is not fully achieved and so
  the state contribution to the healthcare is still
  50 from public finance.
• Since 1993 users have to pay for a share of any
  cost resulting for diagnostic procedures,
  pharmaceuticals, specialist visits called
  TICKET.
• For the elderly people, pregnant women,
  disabled..etc they have specific type of
  exemption.
• Since the private reforms Italians are consumming
  more and more healthcare and they have the
  highest expense in Europe 32.

7
Healthcare delivery system

• Italian are request to go to see their GPs first,
  once he authorised secondary care, then they pay
  a fee of up to 40 euro to see a specialistetc
• Hospital care is delivered mainly by the public
  structure (61 in total) they provide out patient
  and inpatient services. They run their own budget
  like a Trust. One major problem is the dislevel
  of service between south and north
• Admission rate is about 18.3 for 100 patient, and
  the lenght of stay is about 3.6 days.

8
Pharmaceuticals and healthcare technology

• In 1990 the major Delorenzo scandals change the
  centralisation of listed price of pharmaceutical,
  was changed to a reference price policy and in
  1997 generic and sensitive price have been
  introduced by pharmacist and pharma group to
  reduce Italians bills which was to heavy
• In Italy there is no national agency for
  searching, promoting and assessing technology
  only some regional health agencies have appeared.
  Each hospitals and regions can acquire their own
  devices

9
CONCLUSION

• With an ageing population and a low rate of death
  there is a constant increase of healthcare
  demand.
• Italians are turning towards private care systems
• Dislevel between North and South
• No real central orientation is given and each
  region offers a different level of service
• Homecare and Telemedicine are the most developped
  in Europe