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The Health Care System in Italy

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)

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The Health Care System in Italy

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  1. Ministero della Salute The Health Care System in Italy 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. 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 Health Devolution process

  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

  5. 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

  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. 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. 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

  12. 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 )

  13. 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

  14. 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

  15. 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

  16. 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)

  17. NATIONAL HEALTH FINANCING Ministero della Salute

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

  19. CostiRicaviRisultato Tabella 2

  20. CostiRicavi Risultato tabella 2

  21. Main health achievement in Italy Ministero della Salute

  22. The National health System in syntesis Ministero della Salute

  23. The National health System in syntesis Ministero della Salute

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