The health system organization

Size: px

Start display at page:

Download "The health system organization"

Drusilla Hutchinson
8 years ago
Views:

1 The health system organization in Italy, Tuscany, Siena

2 Italian Constitution (1947) Art. 32: The Italian Republic safeguards health as a fundamental right of the individual and as a collective interest and guarantees free medical care to the indigent.

3 Il Servizio Sanitario Nazionale (National Health Service) Created in 1978 (Law 833/78) as a nationwide service based on Beveridge model Funded by general taxation Based largely on public provision Free at the point of use Equity of access to healthcare for all citizens without distiction by age, gender, income, origin Integration of all the healthcare services through the establisment of the Unità Sanitaria Locale (Local Health Organization) controlled by local administrations (municipalities)

healthcare for all citizens without distiction by age, gender, income, origin Integration of all the healthcare services

4 The reforms of the 1990s (Law 502/92 and 517/93) In the 1990s continous increases in the healthcare costs and perceived inefficency created pressure to introduce major reforms including: - decentralization of health policy responsibilities and financial accountability to regional administration - creation of internal market (quasi-market) and competion between regions - delegating significant managerial autonomy to LHO and major hospitals - increases in the role of private sector in healthcare provision

financial accountability to regional administration - creation of internal market (quasi-market) and competion between regions

5 The third reform: reinforcing the regolatory role of the new federal state To prevent each region from providing drastically different levels of healthcare, regulatory measures were launched to promote: - strategic planning - regulate competition - assess the quality of care - promote cooperation Law 229/99: the SSN guarantees a basic benefit package of healthcare to every citizen (LEA); healthcare interventions are excluded from the basic package if they do not meet the principle of effectiveness and appropriateness National Health Plan: every 3 years, should define the basic benefit package of healthcare guaranteed to every citizen (LEA) and outline the main health targets

benefit package of healthcare to every citizen (LEA); healthcare interventions are excluded from the basic package if they do not meet the principle of effectiveness and

6 2012: 21 Regional Health Services pillars of healthcare: Public health and prevention Hospital healthcare Primary health care

7 Human resources of Servizio Sanitario Nazionale (SSN) (1) In 2010: physicians nurses professionals in the field of rehabilitation diagnostics technical professionals Source: Ministry of Health

000 professionals in the field of rehabilitation - 45.

8 Human resources of Servizio Sanitario Nazionale (SSN) (2) Types of contracts: - permanent contract - fixed-term contract - managerial fixed-term contract (art 15 septies 502/92) - fixed-term contract for finalized projects (art 15 octies 502/92) - consultant

managerial fixed-term contract (art 15 septies 502/92) -

9 Human resources of Servizio Sanitario Nazionale (SSN) (3) Physicians can work: - in hospital or in community services as employees of SSN - in primary health care services as General Pratictioners, working as independent physicians under a government contract who are paid a capitation fee based on the number of people belonging to their own list - in specialist ambulatory services provided by LHO or by accredited public or private facilities with which LHO has agreements and contracts

government contract who are paid a capitation fee based on the number of people belonging to their own list - in

10 Human resources of Servizio Sanitario Nazionale (SSN) (4) Contractual areas: - clerks (in the healthcare, techical and administrative sector) - Medical and veterinary managers - non medical managers (in the healthcare, techical and administrative sector) Each area is regualated by: - National Collective Contract - Local integrative contract

managers - non medical managers (in the healthcare, techical and administrative

11 Il Servizio Sanitario della Toscana (Tuscany Health Service) About 4 milions of inhabitants 12 Local Health Units organized in districts 3 Highly Specialized University Hospitals 1 Higly Specialized Cardiovascular Healthcare Institution 1 Higly Specialized Paediatric Hospital health care professional 40 hospitals

University Hospitals 1 Higly Specialized Cardiovascular Healthcare Institution 1

12 Source: WHO Health status in Italy

13 Health status in Tuscany 86 Life expectancy at birth (2010) Males Females Tuscany Italy Avoidable mortality 2002 Males Females Lower quartile Higher quartile Source: Rapporto Osservasalute 2011, Report ERA 2007

Avoidable mortality 2002 Males Females Lower quartile

14 USL 7 Siena: territory and organization USL 7 of Siena covers 36 municipalities and has a population of 272,638 in an area of 3,821 km 2 (pop. density 71,3/km 2 ) SIENA It is organized in 4 Districts: - Alta Val d Elsa (5 municipalities) - Senese (15 municipalities) - Amiata Val d Orcia (6 municipalities) - Val di Chiana Senese (10 municipalities)

density 71,3/km 2 ) SIENA It is organized in 4 Districts: - Alta Val d Elsa (5

15 USL 7 Siena: Organization Chart General Manager Head of the Healthcare Sector Head of Administration Valdelsa District Amiata-Orcia District Valdichiana District Senese District Department Department Department Hospital Manager CAMPOSTAGGIA HOSPITAL NOTTOLA HOSPITAL ABBADIA SS HOSPITAL

Valdichiana District Senese District Department Department Department

16 USL 7 Siena: the budgeting process Each year USL 7 translates its strategies into objectives and resources through the budgeting process. Each Department and District receives objectives that should be reached.

USL 7 Siena: the performamnce assessment The Laboratorio Management e Sanità of Scuola Superiore Sant'Anna-Pisa developed a performance assessment system in order to support the

17 USL 7 Siena: the performamnce assessment The Laboratorio Management e Sanità of Scuola Superiore Sant'Anna-Pisa developed a performance assessment system in order to support the ability of the regional healthcare system and of each healthcare institution and district-zone to be efficient and effective and to deliver adequate services which meet the population s needs.

ability of the regional healthcare system and of each healthcare institution and

18 Provision of services Each District offers health services relating to: - Public health and prevention - Hospital healthcare - Primary healthcare

19 Public Health and Prevention in the USL 7 Siena Public health and prevention activities are delivered by the Dipartimento di Prevenzione (Prevention Department) and include: Activities for the prevention and control of infectious diseases; Safeguard from the risks for health due to the environmental pollution; Preventing occupational diseases and accidents; Food control (production, processing, preservation, commerce and transport), preventing food-related disease and nutritional surveillance (preventing obesity and malnutrition, etc.). Veterinary medicine (surveillance of animal stock health, hygiene of food production and animal food safety and control) Forensic

occupational diseases and accidents; Food control (production, processing, preservation, commerce and transport), preventing food-related disease and nutritional

20 Hospital healthcare Val di Chiana hospital, located in the municipality of Montepulciano in the south of Siena Province (n 156 hospital beds) Alta Val d Elsa hospital, located in municipality of Poggibonsi in the north of Siena Province (n 170 hospital beds) Amiata Val d Orcia hospital, located in municipality of Abbadia San Salvatore (n 34 hospital beds) Hospital healthcare in Senese District is delivered by the Azienda Ospedaliera Senese (University Hospital Le Scotte), an hospital with independent management

beds) Amiata Val d Orcia hospital, located in municipality of Abbadia San Salvatore (n 34 hospital beds) Hospital healthcare in

21 Hospital Departments (1) The aim of the department is to assure Flexibility Speed of comunication Continuity of care Centrality of the customers Development of professional figures (like pharmacists, doctors )

22 Hospital Departments (2) Surgery Emergency Internal Medicine Diagnostic services Critical Care Nursing Oncology Diagnostics technical professionals

23 Department of Mental Health The realization of the new Department of Mental Health is a good point of collaboration beetwen several professional figures of USL 7 of Siena and University Hospital Le Scotte, which collaborate to assure complete health care, and continuity of care between hospital and territory.

24 Primary health care It manages the health and social services at community level through facilities spread on the territory.

25 Role of General Practitioners The main actors of the primary health care system are the GPs They are organized in multipurpose structures where 7-10 GPs can operate with the support of nurses and secretaries and in cooperation with specialistic doctors. In each structure could be also delivered first level diagnostic interventions.

26 Effects of integration An efficient continuity of care has positive effect on patients outcome of health: - It improves perceived quality of healthcare - It prevents inappropriate accesses to healthcare services - It reduces diagnostic exams - It prevents wastes and incresing of waiting times

Azienda USL 7 Siena (Local Health Authority)

Azienda USL 7 Siena (Local Health Authority) Italian Health Care System A short guide for foreign students (Services offered, documents needed, how to register) The key actors are -Azienda USL 7 Siena is the Local Health Authority supplying standard