The Health Care System in Italy

1
The Health Care System in Italy
Ministero della Salute
General Directorate for Eu and International
Relations Dr. Pietro Malara
2
Facts and policies of the National Health Care
System

• Born in 1978 (Law 833)
• State level, regional level, local level (local
  health units)
• Increased responsibility and autonomy of regional
  authorities (LD 502/1992)
• Local health units and main hospitals trasformed
  into Agencies managed by indipendent managers
• Decentralisation process (LD 112/1998) and
  Modification of the National Health System
  structure and organization (DL 229/1999)
• Growing autonomy, responsibility and planning of
  the Regions on the objectives of prevention,
  treatment and rehabilitation

3
Health Devolution process
Ministero della Salute

• Fiscal Federalism (LD 56/2000)
• Changed the health care financing system,
  taxation directly attributed to the Regions,
  national equalisation fund
• Establishment of a system that monitors and
  assesses the delivery of health care according to
  appropriate qualitative and quantitative
  indicators
• Reform of chapter V of the Italian Costitution
  art. 117
• Attributed to Regions the general legislative
  and administrative authority in basic sector of
  society
• The determination of the essential levels of
  services with regards to civil and social rights
  to be guaranteed in the whole country continues
  to pertain to the National Parliament and central
  Government

4
National Health Care System
Ministero della Salute
Government
Ministry of Health
Conf. State-Regions
19 Regions
2 Autonomous Provinces
Local H. Agencies
Univ. Hosp. IRCCS
Hospital Agencies
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National Health Care System
Ministero della Salute
General Practictioners
Pharmacies
Local H. Agencies
Clinic and Laboratories
Hospitals
Hospital Agencies
University Hospitals, IRCCS
Private Hospital
Private clinic and Laboratories
6
Essential levels of health care LEA (
DPCM 29 November 2001)
Ministero della Salute
All citizens are entitled to receive health care
services included in the essential level at no
cost at the point of access or upon payment of a
small share for services that are not fully
covered by the National Health System
necessary appropriate homogeneous
1 Collective health care 2 District
health care 3 Hospital care
Agreement between the Central and Regional
Governments of 8 August 2001 Resources for
financing essential levels of health care were
established and further responsabilities were
given to the Region with regard to the
organization of health services and to control
health expenditures
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1 Collective health care in life and working
environments

• Including all prevention activities addressed
  to the population and to individuals
• Protection from the effects of pollution and
  industrial-accident risk
• Veterinary public health
• Food hygiene control
• Prophylaxis for communicable diseases
• Vaccination
• Early diagnosis programs
• Forensic medicine

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2 District health care

• Including the health and social care services
  distributed throughout the country
• Primary care
• Pharmaceutical assistance
• Local emergency
• Specialist day-hospital services
• Services for disabled and prostheses
• Home care services for the elderly and
  chronically ill people
• Mental health care services
• Semi-residential and residential structures for
  the elderly, disabled, terminal patients,
  substance abusers and alcoholics, HIV-positive
  person
• Hydrothermal treatments

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3 Hospital care

• First-aid emergency response
• Ordinary hospitalisation
• Day hospital and day surgery
• Long term hospital stays
• Rehabilitation hospital
• Home based services provided by hospital staff
• Blood and transfusion services
• Tissue for grafts and trasplants

10
The role of the Ministry of Health

• The Ministry of health will have to act as
  guarantor for the citizens to ensure that their
  rights are fully and uniformly respected and to
  make sure that regulations in place are properly
  implemented
• Complex system of indicators and
  parameters to monitor essential levels of health
  care delivered over the national territory
• National Information System gives data for
  monitoring essential levels of health care

11
Problems related to the system
Ministero della Salute

• Increasing citizens expectations
• Population ageing and consequent increase in
  service demand
• Continuous cost rise determined by scientific
  and technological innovation
• Restrictions imposed to public funding by
  commitments to comply with EU stability treaties

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Objectives of the national health policy
Ministero della Salute

• PREVENTION
• Promotion of the activities of
• Health education (tobacco and alcohol use,
  sedentary lifestyle, obesity, drugs, physical
  activity, road accidents )
• Primary prevention (vaccination)
• Early diagnosis (cancer screening )

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Objectives of the national health policy
Ministero della Salute

• Primary health care
• Re-evaluation of general pratictioners
• Promotion of the territorial primary unit (UTAP)
• Integrated networks for health care and social
  services for chronic patients, the elderly and
  the disabled

Increase of the appropriateness of hospital
services Reduction of inappropriate emergency
admissions
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Objectives of the national health policy
Ministero della Salute

• HOSPITAL STRUCTURES
• Redesigning hospital networks
• Centres of excellence
• Appropriateness of hospital services (different
  settings of care cost-effectiveness)

Ordinary hospitalization
Day-hospital Day-surgery
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Objectives of the national health policy
Ministero della Salute
QUALITY OF HEALTH SERVICES

• High-level permanent training in medicine ECM
• implementation of clinical practice guidelines
  (evidence based medicine)
• Clinical performance measures (es. bypass, hip
  prostesys) and reduction of the clinical risk
• Health Tecnology Assessment
• Reduction of disparities in health status and
  access to care

CLINICAL GOVERNANCE
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Objectives of the national health policy
Ministero della Salute
Health financing

• Attention on aged population (funds for the non
  self-sufficient)

• Increase of resources for prevention and district
  care
• Integration across the public and private sectors
• The proportion of GDP devoted to health is rising
• Public health care expenditure trend from 5.1
  of GDP(1996) to 6.5 (2004)

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NATIONAL HEALTH FINANCING
Ministero della Salute
2004 84.738 millions euro
2005 91.060.
2006 94.985
2007 96.000
2008 99.042
2009 102.683
2010 103.945
2011 106.265
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Current financing and current public health
expenditure (values in millions euro) TABELLA 1
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Costi Ricavi Risultato Tabella 2

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20
Costi Ricavi Risultato tabella 2
21
Main health achievement in Italy
Ministero della Salute
Life expectancy male (EU 75 y) 76
Life expectancy female (EU 81,2 y) 82,1
Age stnd death rate (per 100.000 r.) circolatory system (EU 257,8) 244,2
Age stnd death rate (per 100.000 r.) malignant neoplasms (EU 184,8) 178,9
Infant death rate (per 1.000 born) (EU 5) 4,5
newborn lt 2500 gr. (EU 6,6) 6,4
smokers (EU 29,3) 25
obese (IMC gt 30 ) 8,9
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The National health System in syntesis
Ministero della Salute
Local Health Agencies 195
Hospital Agencies 102
Employees of the National Health System 656.200
physicians and dentists 15,7
nurses 40
Primary care pratictioners 46.907
Patients for primary pratictioner 1.100
Paediatricians 7.257
Children for pediatrics 794
Pharmaceutical prescriptions 449 ml
Beds in the rehabilitation institutes 16.139
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The National health System in syntesis
Ministero della Salute
Other public Hospitals 653
Accredited Private Clinics 531
Hospital ordinary beds in public health care 197.465
per 1.000 residents. 3,65
Acute 183.083
Accredited ordinary beds in private h. care 48.415
per 1.000 residents 0,88
Acute 33.918
Admissions in acute care (ordinary) 8.879.000
Admissions rate (per 1.000 r.) acute ordinary 148
Average length of stay acute care (days) 6,7