Transcript Guidance on Health Buildings: programming of an Hospital

Ministero della Salute
The Health Care System
in Italy
General Directorate for Eu and International Relations
Dr. Pietro Malara
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
2
Ministero della Salute
Health Devolution process
• 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
National Health Care System
Ministero della Salute
Government
Ministry of Health
Conf. State-Regions
19 Regions
Local H. Agencies
2 Autonomous Provinces
Hospital Agencies
Univ. Hosp.
IRCCS
4
National Health Care System
Ministero della Salute
General Practictioners
Pharmacies
Clinic and Laboratories
Local H. Agencies
Hospitals
Hospital Agencies
University Hospitals, IRCCS
Private Hospital
Private clinic and Laboratories
5
Essential levels of health care – LEA
Ministero della Salute
( DPCM 29 November 2001)
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
1 Collective health care
necessary
2 District health care
appropriate
3 Hospital care
homogeneous
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
6
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
7
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
8
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
9
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
10
Ministero della Salute
Problems related to the system
 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
11
Ministero della Salute
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 )
12
Objectives of the national health
Ministero della Salute
policy
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
13
Ministero della Salute
Objectives of the national health
policy
HOSPITAL STRUCTURES
•
Redesigning hospital networks
•
Centres of excellence
•
Appropriateness of hospital services (different
settings of care: cost-effectiveness)
Ordinary
hospitalization
Day-hospital
Day-surgery
14
Ministero della Salute
Objectives of the national health
policy
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
15
Ministero della Salute
Objectives of the national health
policy
Health financing :
•
Attention on aged population (funds for the non selfsufficient)
•
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
16
NATIONAL HEALTH FINANCING
Ministero della Salute
2004
2005
2006
84.738 millions euro
91.060.
94.985
2007
2008
2009
96.000
99.042
102.683
2010
2011
103.945
106.265
17
Current financing and current public health
expenditure (values in millions euro) TABELLA 1
2001
Spesa corrente
in % del pil
incremento %
(a)
Livello del Finanziamento corrente
programmato a cui concorre lo Stato
destinato a tutte le regioni (*)
in % del pil
2003
2004
2005
71.271 75.597 78.564 82.417 90.195
5,71
5,84
6,07
5,88
3,92
5,93
4,90
6,36
9,44
Fondo transitorio di
accompagnamento per le regioni con
elevati disavanzi strutturali
Totale finanziamento
in % del pil
Pil
incremento %
92.173
6,25
2,19
1.000
0,07
in % del pil
(a) + (b)
2006
77.288 81.025 83.742 92.011 98.606 102.134
6,19
6,26
6,27
6,62
6,96
6,92
4,84
3,35
9,87
7,17
3,58
incremento %
(b)
2002
71.271 75.597 78.564 82.417 90.195
5,71
5,84
5,88
5,93
6,36
1.248.648
93.173
6,32
1.295.226
1.335.354
1.388.870
1.417.241
1.475.402
3,73
3,10
4,01
2,04
4,10
18
Costi Ricavi Risultato Tabella 2
2001
Regioni
PIEMONTE
costi
ricavi
5.970
5.781
VALLE D'AOSTA
182
160
LOMBARDIA
12.105 11.469
BOLZANO
776
476
TRENTO
727
738
VENETO
6.156
5.739
FRIULI
1.608
1.569
LIGURIA
2.377
2.290
EMILIA ROMAGNA
5.701
5.471
TOSCANA
4.935
4.763
UMBRIA
1.134
1.109
MARCHE
1.993
1.894
LAZIO
7.495
6.443
ABRUZZO
1.744
1.651
MOLISE
446
422
CAMPANIA
7.423
7.050
PUGLIA
4.924
4.849
BASILICATA
710
739
CALABRIA
2.533
2.478
SICILIA
6.242
6.025
SARDEGNA
2.107
2.051
ITALIA
77.288 73.166
2002
risultato
costi
ricavi
-210
6.032
6.012
-33
193
200
-281 12.930 12.210
-297
864
787
4
769
783
-304
6.406
6.101
-18
1.695
1.706
-77
2.443
2.396
-16
6.061
5.779
-88
5.169
5.052
-7
1.222
1.177
-125
2.088
2.017
-987
7.664
7.025
-76
1.846
1.699
-37
455
438
-629
7.847
7.478
-166
5.112
5.215
-28
735
788
-226
2.592
2.632
-415
6.665
6.523
-106
2.238
2.114
-4.122 81.025 78.134
2003
risultato
costi
ricavi
-40
6.343
6.262
-7
201
205
-323 13.030 12.687
-71
913
881
1
813
821
-204
6.685
6.427
34
1.759
1.761
-44
2.521
2.481
-50
6.308
6.018
-44
5.292
5.227
-10
1.301
1.219
-98
2.119
2.084
-574
8.249
7.487
-136
2.011
1.778
-19
530
454
-638
7.916
7.624
-4
5.282
5.518
-1
783
819
-148
2.615
2.750
-342
6.774
6.711
-175
2.299
2.205
-2.891 83.742 81.419
2004
Regioni
costi
ricavi
PIEMONTE
7.358
6.706
VALLE D'AOSTA
212
215
LOMBARDIA
13.625 13.318
BOLZANO
950
968
TRENTO
844
851
VENETO
7.149
7.039
FRIULI
1.939
1.933
LIGURIA
2.909
2.600
EMILIA ROMAGNA
6.879
6.229
TOSCANA
5.827
5.483
UMBRIA
1.364
1.285
MARCHE
2.345
2.227
LAZIO
9.858
8.146
ABRUZZO
1.985
1.864
MOLISE
531
487
CAMPANIA
8.928
8.007
PUGLIA
5.589
5.784
BASILICATA
836
858
CALABRIA
2.806
2.889
SICILIA
7.608
7.056
SARDEGNA
2.468
2.278
2005
risultato
costi
ricavi
-671
7.530
7.542
-13
228
232
131 15.078 14.641
25
994
1.016
-9
882
895
6
7.732
7.500
9
2.058
2.070
-329
2.968
2.734
-380
7.241
6.936
-240
6.064
5.945
-52
1.443
1.416
-163
2.399
2.425
-1.669 10.473
8.676
-104
2.278
2.023
-44
662
516
-1.182
9.795
8.276
42
6.321
6.083
-31
916
921
-128
2.880
3.013
-748
7.944
7.566
-240
2.721
2.456
Costi Ricavi Risultato tabella 2
ITALIA
92.011
86.221
-5.790
98.606
92.880
2006
risultato
costi
ricavi
1
7.642
7.647
-14
249
253
-14 15.598 15.163
28
1.038
1.057
-3
930
934
-114
8.025
7.985
27
2.031
2.037
-253
3.013
2.923
-16
7.514
7.167
-15
6.384
6.157
-8
1.491
1.435
-18
2.489
2.494
-1.733 10.914
8.939
-241
2.288
2.140
-139
593
515
-1.788
9.404
8.937
-412
6.451
6.466
-43
922
942
-79
3.097
3.277
-574
9.398
8.622
-317
2.664
2.589
-5.725 102.134 20
97.677
Ministero della Salute
Main health achievement in Italy
Life expectancy – male (EU 75 y)
Life expectancy – female (EU 81,2 y)
76
82,1
Age stnd death rate
(EU 257,8)
(per 100.000 r.)
circolatory system
244,2
Age stnd death rate
(EU 184,8)
(per 100.000 r.)
malignant neoplasms
178,9
Infant death rate (per 1.000 born) (EU 5)
% newborn < 2500 gr. (EU 6,6%)
4,5
6,4 %
% smokers (EU 29,3%)
% obese (IMC > 30 )
25
8,9
21
Ministero della Salute
The National health System in syntesis
Local Health Agencies
195
Hospital Agencies
Employees of the National Health System
102
656.200
% physicians and dentists
15,7%
% nurses
40%
Primary care pratictioners
Patients for primary pratictioner
Paediatricians
Children for pediatrics
Pharmaceutical prescriptions
Beds in the rehabilitation institutes
46.907
1.100
7.257
794
449 ml
16.139
22
Ministero della Salute
The National health System in syntesis
Other public Hospitals
653
Accredited Private Clinics
Hospital ordinary beds in public health care
per 1.000 residents.
Acute
531
197.465
3,65
183.083
Accredited ordinary beds in private h. care
per 1.000 residents
Acute
48.415
0,88
33.918
Admissions in acute care (ordinary)
Admissions rate (per 1.000 r.) – acute ordinary
Average length of stay – acute care (days)
8.879.000
148
23
6,7