Improved quality, safety and containing healthcare costs: too good to be true?

Transcription

1 Improved quality, safety and containing healthcare costs: too good to be true? Claudio Dario, Director General, Padua Teaching Hospital, Veneto Region, Italy Bruxelles 21 February 2013

2 The current scenario The effects of the crisis on Italy, as in the other European Countries, are noticeable from multiple factors. In particular: growth of public debt decrease of production and of GDP increase of unemployment

3 Growth of public debt Source: Italian Ministry of Treasure, 2012

4 Growth of public debt Public debt / GDP ratio in UE Contries, 2011 Source: Italian Ministry of Treasure, 2012 [source: Eurostat, 2012]

5 decrease of production and of GDP The Italian GDP and forecasts [Source: The perspectives for italian economy , Italian Bureau of Statistics (ISTAT), 5-nov-2012]

6 Increase of unemployment The amount of Unemployed by class of age (thousands) Source: Italian Bureau of Statistics (ISTAT), 2012

7 The amount of Unemployed by class of age (thousands) Source: OECD, 2013

8 The current scenario But in Italy a good social safety net is in place: extensive use of layoffs ( cassa integrazione ) unemployment compensations ( sussidi di disoccupazione ) family protection network household wealth house of property (the 77,1% of italians live in a house of property*) savings and financial activities [*Source: Survey on savings and financial choices of Italians 2012, Intesa San Paolo, 2012]

9 Extensive use of Layoffs ( cassa integrazione") [Source: Italian Bureau of Statistics, ISTAT, 2012]

10 Household wealth Household wealth to income ratio Household wealth of italians: Billions on 2011 (almost 4 times the public debt) 62,8% of real activities, 37,2% financial activites, 9,5% financial liabilities. 10% of italians owns the 45% of wealth the net wealth is almost 8 times the income [source: Bank of italy, 2011]

11 The Italian National Health Service Italy has a tax-funded National Health Service that guarantees universal provision of comprehensive care Health Insurance coverage The central government provides a politicy and planning frameworks, defines the Essential Levels of Care and guarantees the financial sustainability The regions, through public and private providers, deliver the Essential Levels of Care (sometimes additional to the minimal set defined by the Ministry of Health) and are liable for any deficit Source: Health at a Glance Europe 2012, OECD, 2012

12 The Italian National Health Service In the period the medium increase rate of expenditure was 2,2%, but in it was higher: 7% Source: Italian Ministry of Health, 2012 The total healthcare expenditure is continuosly increasing: the reduction of the increase of the public funding over the years is compensated by a raising private expenditure

13 The deficit of the National Health Service The trend of the deficit of Italian NHS National trend Billion Trend for regions with recovery plan Trend for regions without recovery plan Year Source: Italian Ministry of Health, 2012

14 The deficit of the National Health Service The polarization of the deficit of Italian NHS among some Regions Year 2011 (Million ) -815,1 85% of the total deficit Source: The European House-Ambrosetti, 2012

15 The deficit of the National Health Service In the period Regions generated over 40 Billion of cumulative deficit Public expenditure (Billions ) 77,7 79,5 82,3 91,2 96,8 99,6 103,8 107,1 110,2 111,2 112,9 % on GDP 6,2 6,1 6,2 6,6 6,8 6,7 6,7 6,8 7,3 7,2 7,1 Deficit (Billions ) -3,8-2,9-2,3-6,4-5,7-4,5-3,7-3,5-3,3-2,3-1,8 Source: Italian Ministry of Health, 2012 Since 2001, Italian government establishes limits to the increase of public expenditure Since 2007, regional recovery plans (Piani di Rientro) are adopted for overspending regions On 2010, further policies has been provided by the Ministry to increase traceability, accountability and appropriateness of the Health Service (Patto per la Salute ) 2012: Spending Review

16 The health expenditure of italian NHS Source: OECD Data Health, 2012

17 Reduction of Hospital Beds The areas of action Organization of hospital beds over the territory (Hospital, Elderly Homes, Nursing Homes, etc ) by intensity of care (acute/cronical disease). 3.5 Hospital Beds/1.000 inhabitants on 2010 [Source: OECD], where the European Average is 5.5 Reorganization of the network of Hospital Assistance depending on High Specialty Hub & spoke networks, pathology networks, etc Organization of the continuity of care: Primary care, Home Care, specialistic assistance, palliative care, residential care, etc... Appropriateness of hospital admissions: reduction of the number and of the duration of hospitalizations Conversion of day-hospital activities to out-patient regimen, and of hospitalizations to day-hospital activities, with the introduction of co-payment Activation of week-surgery and development of day-surgery

18 The areas of action The National government cut the transfers to regions for disability, childhood, migrants and other welfare policies Introduction of cost-saving measures aimed to reduce pharmaceutical expenditure Increase of indirect business tax (IRAP) to finance healthcare system Elimination of obsolete Essential Levels of care

19 Improved quality, safety and containing healthcare costs: too good to be true?

20 Thank you! Claudio Dario Director General, Padua Teaching Hospital, Veneto Region, Italy

21 The health expenditure of italian NHS Source: OECD Data Health, 2012