ITALY
Mr Domenico Mantoan
HOPE Governor, Veneto Region
Could you describe the last hospital and/
or healthcare reforms implemented in your
country in the past 5 years?
In the past 5 years, as regards the hospitals, the
most important law is the National Decree
n.70/2015. It states the new hospitals standards
(structural, technological, organisational and
clinical) that have to be applied in each Italian
Region. The decree states that each Italian Region
has to create a network of acute hospitals, based
on three hierarchical levels: basic hospitals
(serving a population of 80,000 - 150,000
inhabitants); first level hospitals (serving
a population of 150,000–300,000 inhabitants);
second level hospitals (serving a population of
600,000–1,200,000 inhabitants). It states, also,
the criteria for the number and type of clinical
departments. For example, cardio-surgery
departments have to serve a population between
600,000 and 1,200,000 inhabitants. The decree
states also the operative standards; for example,
each breast surgery department has to treat at
least 150 cancer cases per year.
As regards general aspects of healthcare,
a National law was approved in January 2017,
regarding the new so-called essential levels of
assistance (LEA – Livelli Essenziali di Assistenza).
The LEA represents the minimum levels of health
services that have to be provided by the Italian
National Health System (NHS) through public
national funding. Some LEA must be provided
for free (that is, acute hospital inpatient services)
whereas others need to be covered through
a co-payment from the patient. New LEA
legislations have come after a long period without
any national update. In fact, the last (and first)
national LEA legislation was in 2001.
As regards the healthcare reform, an
innovative regional reform commenced in Veneto
in 2016. It is based on two main topics: the
reduction of the number of Health and Social
Local Trusts (HSLTs) and the creation of an
innovative Trust, called Zero Trust (Azienda Zero),
which absorbed some functions – mainly
administrative – that were previously performed
by other Trusts or regional offices. The Zero Trust
does not provide any clinical services. It was
conceived with the aim of increasing efficiency
and productivity through a more effective use of
resources, following a unified approach.
Could you present two/three elements on
the impact of such reforms on hospital and/
or healthcare sectors that your organisation/
country has identified?
Regarding national hospitals standards, each
region had to reorganise its inpatient settings by
reducing the number of acute hospital beds. The
organisational impact was important because
outpatient care and home care were
strengthened. Country hospitals were
implemented too. Hospitals teams are encouraged
to work in network. Clinical networks
(oncological, cardiologic and emergency
networks) were created. Some departments were
closed such as the surgery departments being
under standard in terms of number of
interventions.
As regards new LEA legislation, it has
introduced some free vaccinations that previously
were not covered, namely vaccinations against
papilloma virus, meningococcus and
pneumococcus. The introduction of new
screening tests in newborns, such as tests for
congenital deafness and cataract, had an
important impact. For disabled individuals, new
information technology was introduced. For
example, eye gaze control systems and speech
generating devices are covered for severe stages
of paralysis (such as in severe amyotrophic lateral
sclerosis). At the same time, the new LEA
In Italy, each
region had to
reorganise its
inpatient settings
by applying
reductions of
acute hospitals
beds. The
organisational
impact was
important since
outpatient
care and home
care were
strengthened
ITALY
Total current health expenditure as % of Gross Domestic Product (GDP)
General government/compulsory current health expenditure as % of total current health expenditure
Hospital current health expenditure, as % of total current health expenditure
Household out-of-pocket health expenditure as % of total current health expenditure
All hospital beds per 100,000 inhabitants
Acute care hospital beds per 100,000 inhabitants
Acute care admissions/discharges per 100 inhabitants
Average length of stay for acute care hospitals (bed-days)
Practising physicians per 100,000 inhabitants
Practising nurses per 100,000 inhabitants
19
HHE 2019 | hospitalhealthcare.com
2002
7.9%
75.0%
n.a.
24.1%
444.0
392.0
15.6
6.7
357.0
427.0
2008 2016
8.6%
8.9%
77.7%
74.5%
46.4%
45.5%
21.3%
23.1%
379.0
317.0
318.0
262.0
13.1
10.4
6.8
6.9
379.0
395.0
473.0
557.0