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Economic crisis in Italy


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Economic crisis in Italy, by Doctor Jacopo Demurtas, at II Forum Vasco da Gama Movement

Published in: Health & Medicine
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Economic crisis in Italy

  1. 1. CRISIS Danger or Opportunity? Jacopo Demurtas piIgs
  2. 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. 3. Ireland Greece Portugal Spain Italy Health expenditure, public and private, as a share of GDP, OECD countries, 2012 or latest year
  4. 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. 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. 6. Health expenditure growth rates (in real terms) since 2004, Italy and OECD average
  7. 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. 8. • Multiple ASLs combine to form a Health Districts Network. • All the primary care services are delivered within this network
  9. 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. 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. 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. 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. 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. 14. What are we actually doing???
  15. 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. 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. 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. 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. 19. “nothing arises from diamonds, from manure flowers blossom” F. De André