The document discusses healthcare spending and primary care delivery in Italy. It notes that healthcare spending as a percentage of GDP in Italy is close to the OECD average, and is funded mostly through public sources. However, an aging population and rise in chronic diseases is straining resources. The document examines efforts by Italian general practitioners to strengthen primary care networks and adopt chronic care models to better serve patients, though this must be done without increasing budgets. It concludes that GPs will continue implementing strategies to improve care coordination and access through new primary care units and networks, despite political shortsightedness and bureaucracy.

1. CRISIS
Danger or Opportunity?
Jacopo Demurtas
piIgs

2. Introduction
• Health spending accounted for 9.2%
of GDP in Italy in 2012, very close
to the average of 9.3% in OECD
countries.
• Health spending as a share of GDP
is much lower in Italy than in the
United States and in a number of
European countries

3. Ireland
Greece
Portugal
Spain
Italy
Health expenditure, public and private, as a share of
GDP, OECD countries, 2012 or latest year

4. • The public sector is the main source
of health funding in nearly all OECD
countries.
• In Italy, 77% of health spending was
funded by public sources in 2012,
slightly more than the average of 72%
in OECD countries.

5. As in many other European
countries, health spending
in Italy has fallen in
recent years, as part of
government efforts to
reduce budgetary deficits
following the economic
crisis.

6. Health expenditure growth rates (in real terms)
since 2004, Italy and OECD average

7. Background
• Italian GP works under a
government contract as
independent professional according
to a collective agreement (ACN)
supplemented by regional
agreements (AIR)
• The health services are delivered in
ASLs (Local Health Authorities)

8. • Multiple ASLs combine to
form a Health Districts
Network.
• All the primary care services
are delivered within this
network

9. Background
• The GP is paid with a mixed system
comprising capitation (from 2009
40,05 euro per capita) and fee-for-
services sums, ranging from 5 to 25
euros. The most important services are
the ADI and ADP service and other
services called PIPs (Prestazioni
Incentivanti Professionali ), negotiated
in ACN and AIR.

10. • The capitation amount is adjusted
according to age of patients,
number of patients (a GP can
currently register up to 1500
patients) and condition of working
in group practices or having a
nurse/nurses or additional
amministrative and IT staff

11. Background
• Italy offers a high quality of primary
care service according to OECD
But…
• Growing ageing population and demographic shift
• Increased prevalence of chronic disease
(eg.dementia)
• Growing prevalence of obesity among children
• Lack of funding, or better: unwillingness to invest
in healthcare
Makin’it tough

12. • According to OECD:
– Efforts are needed to increase
transparency, develop performance
measurement, strengthen accountability
– Italy should develop a set of standard
around processes and outcomes of
primary care
– Involve more primary care physicians in
preventive activities
– Italian authorities should consider
enhancing quality initiatives in PC sector

13. • Increasing initiatives aimed at guaranteeing
high quality of PC services. These initiatives
range from the process of strengthening the
information system, developing quality
standards and setting up smarter payment
system, to mechanism aimed at enhancing
preventives activities into the primary care
sector.
• Consolidating the development of community
care networks or community hospitals to
encourage co-ordination and integration of
care, specifically for patients having chronic
and long terms conditions.

14. What are we
actually doing???

15. According to Balduzzi Law (Legge
189/12) and last Patto della Salute
Italian GP is:
• Trying to set networks of general
practitioners (AFTs)
• Promoting and strenghtening
territorial delivery of primary care by
adopting Chronic Care Model (CCM) to
serve patients with chronic illnesses
(e.g. COPD, Diabetes, Heart Failure)

16. • Coping with the fact that
the necessary modifications
within the system should be
done without an increase of
the National Health Service
budget

17. Conclusions
• Considering the shortsightedness of our
politicians we’re trying to implement
strategies to take care of our patients,
upgrading the CCM, developing territorial
functional aggregations of GPs (AFT) which
will be followed by complex primary care
units (UCCPs) in which there will be room
for GPs and for specialists to offer better
healthcare to our patients.

18. • The GP in our system is really
important, he’s the key for primary
care delivery, and our patients feel it
although our politicians and authorities
do not.
• The GPs are overwhelmed with
bureaucracy
• And…
• Just like Pigs or PIIGS we’re twisting
in mud and manure

19. “nothing arises from diamonds,
from manure flowers blossom”
F. De André

20. ARRIVEDERCI
IN
ITALIA