The Health Care System in Italy General Directorate for Eu and International Relations Dr. Pietro...

The Health Care System in Italy

The Health Care System in Italy

General Directorate for Eu and International RelationsDr. Pietro Malara

Ministero della Salute

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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

Health Devolution processMinistero 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

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National Health Care System

Government

19 Regions

Conf. State-Regions

Ministry of Health

Hospital AgenciesLocal H. Agencies

2 Autonomous Provinces

Univ. Hosp. IRCCS


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National Health Care System

Private Hospital

General Practictioners

Hospital Agencies

Local H. Agencies

University Hospitals, IRCCS


Pharmacies

Clinic and Laboratories

Hospitals

Private clinic and Laboratories

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1 Collective health care

2 District health care

3 Hospital care

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

Essential levels of health care – LEA ( DPCM 29 November 2001)

necessarynecessary

appropriate appropriate

homogeneoushomogeneous

Agreement between the Central and Regional Governments of 8 Agreement between the Central and Regional Governments of 8 August 2001August 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 Including all prevention activities addressed to the population and to addressed to the population and to individualsindividuals

• 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 Including the health and social care services distributed throughout the services distributed throughout the countrycountry

• 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

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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

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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

Problems related to the systemProblems related to the systemMinistero

della Salute

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Objectives of the national health policy

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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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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HOSPITAL STRUCTURES

• Redesigning hospital networks

• Centres of excellence

• Appropriateness of hospital services (different settings of care: cost-effectiveness)



Ordinary hospitalization

Day-hospitalDay-surgery

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• 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

QUALITY OF HEALTH SERVICES


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

Health financing :


• 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)

Prev; 3,6

District; 48,3

Hosp; 48,1

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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

NATIONAL HEALTH FINANCING


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Current financing and current public health expenditure (values in millions euro) TABELLA 1

2001 2002 2003 2004 2005 2006

Spesa corrente 77.288 81.025 83.742 92.011 98.606 102.134 in % del pil 6,19 6,26 6,27 6,62 6,96 6,92incremento % 4,84 3,35 9,87 7,17 3,58

(a)

Livello del Finanziamento corrente programmato a cui concorre lo Stato destinato a tutte le regioni (*)

71.271 75.597 78.564 82.417 90.195 92.173

in % del pil 5,71 5,84 5,88 5,93 6,36 6,25incremento % 6,07 3,92 4,90 9,44 2,19

(b)

Fondo transitorio di accompagnamento per le regioni con elevati disavanzi strutturali

1.000

in % del pil 0,07

(a) + (b) Totale finanziamento 71.271 75.597 78.564 82.417 90.195 93.173in % del pil 5,71 5,84 5,88 5,93 6,36 6,32

Pil 1.248.648 1.295.226 1.335.354 1.388.870 1.417.241 1.475.402

incremento % 3,73 3,10 4,01 2,04 4,10

Costi Ricavi Risultato Tabella 2

Regioni costi ricavi risultato costi ricavi risultato costi ricavi

PIEMONTE 5.970 5.781 -210 6.032 6.012 -40 6.343 6.262VALLE D'AOSTA 182 160 -33 193 200 -7 201 205LOMBARDIA 12.105 11.469 -281 12.930 12.210 -323 13.030 12.687BOLZANO 776 476 -297 864 787 -71 913 881TRENTO 727 738 4 769 783 1 813 821VENETO 6.156 5.739 -304 6.406 6.101 -204 6.685 6.427FRIULI 1.608 1.569 -18 1.695 1.706 34 1.759 1.761LIGURIA 2.377 2.290 -77 2.443 2.396 -44 2.521 2.481EMILIA ROMAGNA 5.701 5.471 -16 6.061 5.779 -50 6.308 6.018TOSCANA 4.935 4.763 -88 5.169 5.052 -44 5.292 5.227UMBRIA 1.134 1.109 -7 1.222 1.177 -10 1.301 1.219MARCHE 1.993 1.894 -125 2.088 2.017 -98 2.119 2.084LAZIO 7.495 6.443 -987 7.664 7.025 -574 8.249 7.487ABRUZZO 1.744 1.651 -76 1.846 1.699 -136 2.011 1.778MOLISE 446 422 -37 455 438 -19 530 454CAMPANIA 7.423 7.050 -629 7.847 7.478 -638 7.916 7.624PUGLIA 4.924 4.849 -166 5.112 5.215 -4 5.282 5.518BASILICATA 710 739 -28 735 788 -1 783 819CALABRIA 2.533 2.478 -226 2.592 2.632 -148 2.615 2.750SICILIA 6.242 6.025 -415 6.665 6.523 -342 6.774 6.711SARDEGNA 2.107 2.051 -106 2.238 2.114 -175 2.299 2.205ITALIA 77.288 73.166 -4.122 81.025 78.134 -2.891 83.742 81.419

20032001 2002

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Costi Ricavi Risultato tabella 2

Regioni costi ricavi risultato costi ricavi risultato costi ricavi

PIEMONTE 7.358 6.706 -671 7.530 7.542 1 7.642 7.647VALLE D'AOSTA 212 215 -13 228 232 -14 249 253LOMBARDIA 13.625 13.318 131 15.078 14.641 -14 15.598 15.163BOLZANO 950 968 25 994 1.016 28 1.038 1.057TRENTO 844 851 -9 882 895 -3 930 934VENETO 7.149 7.039 6 7.732 7.500 -114 8.025 7.985FRIULI 1.939 1.933 9 2.058 2.070 27 2.031 2.037LIGURIA 2.909 2.600 -329 2.968 2.734 -253 3.013 2.923EMILIA ROMAGNA 6.879 6.229 -380 7.241 6.936 -16 7.514 7.167TOSCANA 5.827 5.483 -240 6.064 5.945 -15 6.384 6.157UMBRIA 1.364 1.285 -52 1.443 1.416 -8 1.491 1.435MARCHE 2.345 2.227 -163 2.399 2.425 -18 2.489 2.494LAZIO 9.858 8.146 -1.669 10.473 8.676 -1.733 10.914 8.939ABRUZZO 1.985 1.864 -104 2.278 2.023 -241 2.288 2.140MOLISE 531 487 -44 662 516 -139 593 515CAMPANIA 8.928 8.007 -1.182 9.795 8.276 -1.788 9.404 8.937PUGLIA 5.589 5.784 42 6.321 6.083 -412 6.451 6.466BASILICATA 836 858 -31 916 921 -43 922 942CALABRIA 2.806 2.889 -128 2.880 3.013 -79 3.097 3.277SICILIA 7.608 7.056 -748 7.944 7.566 -574 9.398 8.622SARDEGNA 2.468 2.278 -240 2.721 2.456 -317 2.664 2.589ITALIA 92.011 86.221 -5.790 98.606 92.880 -5.725 102.134 97.677

2004 20062005

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Life expectancy – male (EU 75 y) 76

Life expectancy – female (EU 81,2 y) 82,1Age 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 < 2500 gr. (EU 6,6%) 6,4 %

% smokers (EU 29,3%) 25

% obese (IMC > 30 ) 8,9

Main health achievement in ItalyMain health achievement in ItalyMinistero

della Salute

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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

The National health System in The National health System in syntesissyntesis


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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

The National health System in The National health System in syntesissyntesis


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