1. The Health Care System in Italy General Directorate for Eu and International Relations Dr. Pietro Malara Ministero della Salute

2. 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. 4 National Health Care System Government 19 Regions Conf. State-Regions Ministry of Health Hospital Agencies Local H. Agencies 2 Autonomous Provinces Univ. Hosp. IRCCS Ministero della Salute

5. 5 National Health Care System Private Hospital General Practictioners Hospital Agencies Local H. Agencies University Hospitals, IRCCS Ministero della Salute Pharmacies Clinic and Laboratories Hospitals Private clinic and Laboratories

6. 6 Ministero della Salute 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) necessaryappropriatehomogeneous 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

7. 7 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

8. 8 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

9. 9 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. 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. 11  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 system Ministero della Salute

12. 12 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 ) Ministero della Salute

13. 13 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 Ministero della Salute Increase of the appropriateness of hospital services Reduction of inappropriate emergency admissions Objectives of the national health policy

14. 14 HOSPITAL STRUCTURES Redesigning hospital networks Centres of excellence Appropriateness of hospital services (different settings of care: cost-effectiveness) Ministero della Salute Objectives of the national health policy Ordinary hospitalization Day-hospital Day-surgery

15. 15 Ministero della Salute 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 Objectives of the national health policy

16. 16 Ministero della Salute Attention on aged population (funds for the non self- sufficient) Health financing : Objectives of the national health policy 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)

17. 17 200484.738 millions euro 200591.060. 200694.985 200796.000 200899.042 2009102.683 2010103.945 2011106.265 NATIONAL HEALTH FINANCING Ministero della Salute

18. 18 Current financing and current public health expenditure (values in millions euro) TABELLA 1

19. Costi Ricavi Risultato Tabella 2

20. 20 Costi Ricavi Risultato tabella 2

21. 21 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 < 2500 gr. (EU 6,6%)6,4 % % smokers (EU 29,3%)25 % obese (IMC > 30 )8,9 Main health achievement in Italy Ministero della Salute

22. 22 Local Health Agencies195 Hospital Agencies102 Employees of the National Health System656.200 % physicians and dentists15,7% % nurses40% Primary care pratictioners46.907 Patients for primary pratictioner1.100 Paediatricians7.257 Children for pediatrics794 Pharmaceutical prescriptions449 ml Beds in the rehabilitation institutes16.139 The National health System in syntesis Ministero della Salute

23. 23 Other public Hospitals653 Accredited Private Clinics531 Hospital ordinary beds in public health care197.465 per 1.000 residents.3,65 Acute183.083 Accredited ordinary beds in private h. care48.415 per 1.000 residents0,88 Acute33.918 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 syntesis Ministero della Salute