Favaretti fontana boston dr foster (2) 2011

1 © Azienda Ospedaliero-Universitaria Santa Maria della Misericordia di Udine

Fabrizio Fontana, CMO and Carlo Favaretti, CEO Hospital and University Trust Udine (Italy)

The Italian Na,onal Health Service


THE ITALIAN NATIONAL HEALTH SERVICE

•  1978 reform: universal coverage granted as constitutional right; organized across 3 levels (national, regional, local)

•  1992 reform: market mechanisms (purchaser/provider shift); local healthcare trusts and hospital trusts; regionalization

•  1999 reform: market mechanisms softening ; regionalization strenghthening (21 regional health services); evolving fiscal devolution; university hospitals integrated in hospital trusts

•  2001 Constitutional reform: healthcare under responsibility of Regions and autonomous Provinces


GOVERNANCE CHANGES IN THE ITALIAN NHS

•  1978 reform: no CEO; management by consensus through political boards elected by Municipalities

•  1992 reform: CEO appointed by Regional Governments; directive management

•  1999 reform: CEO appointed by Regional Governments; CEO accountable to Region, Municipalities and other stakeholders including patients and professionals


PROBLEMS OF GOVERNANCE IN HEALTH CARE SECTOR

•  THERE IS NO N.H.S. AGENCY FOR SETTING QUALITY STANDARDS AND PROVIDING GUIDANCE ON ACCEPTED USES OF THE TOOLS AVAILABLE IN MEDICINE

•  DEFENSIVE MEDICINE IS WIDELY INCREASING DUE TO THE FEAR OF PENAL CODE

•  MISUSE OF RESOURCES AND ECONOMICAL CONTINGENCY CREATE DIFFICULTIES


HUGE PERFORMANCE DIFFERENCES IN PROVIDING

HEALTH CARE BETWEEN NORTH AND SOUTH

MIGRATION OF PATIENTS FROM

SOUTH TO NORTH

TRANFERRING ECONOMIC RESOURCES TO COMPENSATE

EXPENSES FROM SOUTH TO NORTH


SOLUTIONS

 TO REDUCE THE DIFFERENCES IN HEALTH CARE FIELD AMONG REGIONS

 TO ENSURE A MINIMUM HEALTH CARE LEVEL TO ALL THE POPULATION IN THE COUNTRY

  NATIONAL BASIC HEALTH CARE PACKAGES

  NATIONWIDE AUTHORIZATION AND ACCREDITATION MECHANISMS


To improve is human

Fabrizio Fontana, M.D Carlo Favaretti, M.D.

Hospital and University Trust S. Maria della Misericordia - Udine (Italy) [email protected]

Favaretti fontana boston dr foster (2) 2011

Health & Medicine

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