7. LTC system
• Definition ????
• National & local taxation are main funding sources of
public LTC.
• Homecare funded mostly by households
• Informal immigrant carers
• Ukraine immigrants
• “Without them, the national health system would edge
towards collapse.”
• Supply and Cost Vary
• Health Services
• Social Care Services
9. Differences and the
enduring debate
Northern Italy
• Care is widespread
• High female participation in
labor market
• More developed
management capabilities
and larger economic
resources
• Want a national, integrated
LTC system
Southern Italy
• Care burden rests on
family
10. Problems with LTC
• Severity of need is assessed differently by regions
• Municipalities are managed at the local level
• Each region has own classification system.
• However try to use international standards for the Geriatric
Evaluations
• No legal definition of persons that need care.
• Instrumental abilities have a secondary role
• Not taken into consideration or they are evaluated but not used
to calculate the level of need.
• Besides ADL, the Cumulative Illness rating Scale or
International Classification of Disease is used.
11. Management
• Italian National Health Service plans and manages
through Local health Units
• Home health services called integrated domicilary
care
• Municipalities -Personal social services domestic
and personal care tasks and institutional social care
are managed at the local level.
12. Governmental Differences
Central Government
• Has the power to set
system wide rules
• Responsible for monitoring
provision services
• Does it actually happen?
Regional
Government
• Responsible for quality
control on private
accredited providers
• Responsible for the
organization and
administration of publicly
funded healthcare
• Budgetary Balance Plans
13. Italian government
• The Italian National Health Service
• 1978
• Aims at providing uniform and comprehensive care
• Financed by general taxation
• Constantly undergoing reform
• 1989 : First Parliament Act was schedule
• Created 140,000 beds for non-self reliance people
• The Objective Project
• National Health Plan
• 2003 – 2005
• 2006 – 2008
14. Current Changes
• Rapid growth of demand for LTC systems
• Rapid Aging
• Family Structure
• More females in the Labor force
• New Ring-Fenced Fund
• Attempting to allocate resources at a national level instead
of a regional level
• LTC National Funds first available in 2010
• Agreement for the New Health Pact of 2010-2012
From 2000 – 2010, Italy had the “Mouse in the Python”
Narrow grouping in younger demographics, with a larger mass of older people aging
It’s projected that over time Italy’s demographics will balance out more
People are living longer and the fertility rate is decreasing
Life expectancy at birth is 80 years for males and 85 for female
Probability of dying under the age of 5 (per 1,000 live births) is 4%
Probability of dying of dying between the age of 15 and 60 (per 1,000 population) is 73% for males and 40% for females
Why do we think such a big gap?
In the United States, our homecare is funded differently ; Medicare
Ukraine immigrants make about $750 to $900 a month!
Saving the Italian economy
HEALTH SERVICES include outpatient and home services, semi-residential and residential services, psychiatric services.
Home health services called integrated domicilary care
SOCIAL CARE SERVICES are provided at the local level which include group interventions that are provided in nursing homes or semi-residential institutions
COMMUNITY CARE
RESIDENTIAL CARE
CASH BENEFITS provided and funded to all disabled persons independently from their age and economic conditions. Not linked to purchasing LTC services but is considered part of the system.
Provided by the National Institute of Social Security (INPS)
Similar to Medicare Waiver
Northern Italy :
Advocate for the creation of a national system
Southern Italy :
Southern Italy is poor and they receive little public support
BOTH : Current main obstacle is funding because of Italy’s high public debt
Debates have been going on since the early 90s in regards to reforming the LTC system
Municipalities -Personal social services, domestic and personal care tasks, and institutional social care
In comparison to the US – we use the DSM IV to classify diseases
REGIONAL GOVERNMENT :
Regions have responsibility for the organization and administration of publicly financed healthcare, regardless of central governments bonds and parameters, such as max bed/resident, celling for pharmaceutical expenditure.
Regions with High Debt must undergo Budgetary Balance Plans that must be implemented by the central government
Socialist run government
The Italian National Health Service (SSN) is Italy’s version of national health care
Similar to our Obamacare
Manages, plans and organizes health care through local units
The Objective Project “healthcare for elder people” approved in the National Health Plan 1992-1994 gave role to Evaluation Units for needs of assessment
National Health Plan
In November 2000 the National Law attempted to establish a minimum level of social care services to provide throughout the country.
National Health Plan (2003-2005) “cash and care” approach implying transferring money to families for purchasing health and social services qualified providers, aimed at supporting home care.
National Health Plan 2006-2008 identified strengthening home care as a first priority as opposed to instutional care.
New Ring-Fenced Fund approved in 2007- 100 million euros to implent the essential levels of care to non self sufficent persons over the country as a whole
