CRISISDanger or Opportunity?

Jacopo Demurtas

piIgs

Introduction

• Health spending accounted for 9.2%of GDP in Italy in 2012, very closeto the average of 9.3% in OECDcountries.

• Health spending as a share of GDPis much lower in Italy than in theUnited States and in a number ofEuropean countries

IrelandGreece

PortugalSpain

Italy

Health expenditure, public and private, as a share of GDP, OECD countries, 2012 or latest year

• The public sector is the main sourceof health funding in nearly all OECDcountries.

• In Italy, 77% of health spending wasfunded by public sources in 2012,slightly more than the average of 72%in OECD countries.

As in many other Europeancountries, health spendingin Italy has fallen inrecent years, as part ofgovernment efforts toreduce budgetary deficitsfollowing the economiccrisis.

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

Background

• Italian GP works under agovernment contract asindependent professional accordingto a collective agreement (ACN)supplemented by regionalagreements (AIR)

• The health services are delivered inASLs (Local Health Authorities)

• Multiple ASLs combine to form a Health DistrictsNetwork.

• All the primary care servicesare delivered within thisnetwork

Background• The GP is paid with a mixed system

comprising capitation (from 200940,05 euro per capita) and fee-for-services sums, ranging from 5 to 25euros. The most important services arethe ADI and ADP service and otherservices called PIPs (PrestazioniIncentivanti Professionali ), negotiatedin ACN and AIR.

• The capitation amount is adjustedaccording to age of patients,number of patients (a GP cancurrently register up to 1500patients) and condition of workingin group practices or having anurse/nurses or additionalamministrative and IT staff

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

• According to OECD:– Efforts are needed to increasetransparency, 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 considerenhancing quality initiatives in PC sector

• Increasing initiatives aimed at guaranteeinghigh quality of PC services. These initiativesrange from the process of strengthening the information system, developing qualitystandards and setting up smarter paymentsystem, to mechanism aimed at enhancingpreventives 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.

What are weactually doing???

According to Balduzzi Law (Legge189/12) and last Patto della SaluteItalian GP is:

• Trying to set networks of generalpractitioners (AFTs)

• Promoting and strenghteningterritorial delivery of primary care byadopting Chronic Care Model (CCM) toserve patients with chronic illnesses(e.g. COPD, Diabetes, Heart Failure)

• Coping with the fact thatthe necessary modificationswithin the system should bedone without an increase ofthe National Health Servicebudget

Conclusions• Considering the shortsightedness of our

politicians we’re trying to implementstrategies to take care of our patients,upgrading the CCM, developing territorialfunctional aggregations of GPs (AFT) whichwill be followed by complex primary careunits (UCCPs) in which there will be roomfor GPs and for specialists to offer betterhealthcare to our patients.

• 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

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

ARRIVEDERCI

IN ITALIA