1. THE USE OF COVER SYSTEMS RE- USABLE IN ITALIAN PRIVATE HEALTH Amsterdam 31-05-2011 Dr. Paoletti Egidio Central Director ALSCO Italy

2. National Health Service (SSN) The National Health Service (SSN) is a group of roles and assistance developed to guarantee to protect health. It is a mixed system involving public and private bodies SSN is split up as follows: - On a central level: the SSN is financed by the State via a National Health Fund - On a regional level: state financing is distributed through the various Regions and these are the Regions which manage the resources

3. Not all of the regions manage the funds with caution: there are balance sheet deficit problems in some regions. In past years the State has re-planned the regional deficits, but is currently compelling the not so virtuous Regions to cut costs to optimise health costs. Deficit re-entry policies are determining high delays in payments for the suppliers of assets and services both for the public and accredited private sectors. SSN characteristics and criticity

4. Private structures are for the most part accredited or agreed with the Regions and supply services that public structures are not able to distribute. Payment for services to the private accredited sector happens with a pathology price list: in the past it was based on days of confinement to bed. Integral health assistance (insurance policies) is not very widespread: for such a reason private structures not accredited with the SSN are few. SSN characteristics and criticity

5. Italian health sector sizing Number of hospitals 2004 2008 % Public hospitals 672 645 - 4.1 Accredited private 531 541 +1.80 Total 1203 1186 -1.41 Source 2008 Report, Ministry of Health Reduction in the number of public hospitals followed in particular by the closure of small public centres with low qualified services and with high costs (eg small peripheral hospitals) Aim: to rationalize costs

6. Accredited private and public health distribution Number of beds 2008 % Public hospitals 171.823 78.4 Accredited private hospitals 47.179 21.6 Total 219.002 100 Average number of beds 2008 Public hospitals 266 Accredited private hospitals 87 Source 2008 Report, Ministry of Health Clear prevalence of the public health part with regard to private accredited hospitals. Public hospitals are on average three times larger than accredited private hospitals. If potential data is considered a phenomenon related with the progressive average cost of living in Italy is to be noted: beds are reduced for serious cases and have been increased for the elderly confined long term.

7. Accredited private health and public health distribution No of beds 78.4% 21.6%

8. Number of ordinary recovery operations: 3,013,000 The most frequent ordinary recovery surgical operations are: - Caesarian birth (212,000) - Colecistectomy (100,000) - Inguinal hernia (93,000) - Hip replacement ( 82,000 ) Day hospital operations: 1,691,000 Cataract operations on crystal are the most frequent in day hospital (340,000) Surgical Operations: public and private structures Fonte Rapporto 2005, Ministero della Salute

9. Number of operations in accredited private hospitals Disaggregated data on surgery in private accredited hospitals is not available but presumes a certain relationship between surgical operations and the number of beds. A correct assessment can be estimated at 940,800 (20% in total) which is the number of operations carried out in Italy in private hospitals accredited with SSN.

10. Accredited private hospitals operations distribution estimate 80% 20% No of surgical operations

11. Re-usable technical fabric market (TTR) in Italy Average consumption per operation: Kg 3.5 Average sale price per kg: 7 Total billing if all operatations in accredited private hospitals in ITaly were carried out with TTR 23,049,600 From the billing from companies that operate in the sector it can be estimated that around 50% of the operations are carried out with TTR

12. Accredited private health cover systems market distribution estimate 15% 35%

13. TTR vs TNT Comfort Client proximity (no storage) Kit composition flexibility Reduced environmental impact TTR strong points

14. TTR vs TNT TNT strong points Price Procedural kit offer

15. Conclusions Today TTR occupies around 50% of the private health market in Italy. The cost constitues an even more discriminatory factor particularly from a costs rationalisation point of view with regard to the expenditure invested by Italian public and private health. Great effort is necessary from TTR production (textile, accessory and industrial laundry suppliers) to maintain and consolidate the positions gained by TTR in the Italian private health market.

16. Thank you for your attention!!!