HHE HOPE 2019 - Page 19

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