Health Delivery and Organization in Italy
Government Regulation
The Ministry of Health oversees all healthcare activities in every region of Italy. There are twelve different administrations that make up the Ministry of Health and are in control of different health areas. Health care planning, essential levels of care, health system ethics, human resources, health professionals, information systems, pharmaceuticals, and medical devices are some of the health care administration areas. The National Health Council and the National Institute of Health are the primary administrators of the Ministry of Health. The primary administrator of public health is the National Institute of Public Health. Monetary monitoring is provided by the National Committee for Medical devices. Fees for medical services are decided by the National Committee for Medical Devices through the process of analyzing costs verses benefits. The responsible party for preforming effectiveness comparisons between the regions is the Agency for Regional Health Services. Prescription management involving the cost of drugs and whether or not they are able to be reimbursed for is determined by the National Pharmaceutical Agency. Servizio Sanitario Nazionale (SSN) is the public segment of healthcare in each region that is coordinated by the Ministry of Health. There are four hundred plus private hospitals. Eighty percent of private hospitals are accredited by the SSN (The Commonwealth Fund, 2016).
Each region is in charge of hospital and specialist fees and national rates are determined by the Ministry of Health. There are 200 regional bureaus that observe and judge the character of health care. These bureaus are known as local health authorities or ASL. The data from these observations is used to contrast with other region’s data for scientific purposes and efficiency. ”Pacts for Health” are agreements sometimes endorsed by the local health authorities and the national government for supplementary funds to implement increase success of healthcare preparation and objectives (The Commonwealth Fund, 2016). ASLs also operate the majority of acute care hospitals.
Ufficio Relazioni con il Pubblico is the office for public relations that oversees the character of health services from the consumers aspect. They often are educators to Italian residents on material involving health and health care issues. Each region is responsible for monitoring and ensureing autonomy and justice of patients. Regional cabinets whose panel consists of civilians and government members is one method that regions have elected to utilize for monitoring (The Commonwealth Fund, 2016).
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| (The Commonwealth Fund, 2016) |
Role of Advanced Nursing Roles in Delivering Healthcare
In Italy the role that is similar to an advanced practice nurse is Infermiere Specialista or Nurse Specialist. This role is recognized as a foreign licensure but is not nationally certified. In 2006 a national regulation was created that made the title with educational obligations of a master’s degree but application has not been established. Currently there is no legal difference in the role of a registered nurse and a Nurse Specialist. In Italy, every nurse is qualified to perform all interventions if they experience and education allow with the exception of prescribing and diagnosing. Nurses are allowed to perform invasive procedures such as intubation and line insertion without the presence of a physician (Kruth, 2015).
Role of Healthcare Professional in Delivering Healthcare and Funding
National income taxes and VAT or regional taxes fund the health care structure. Central and regional governments pay providers by means of established wages and by diagnosis related group repayments. The central government divides tax revenues for public healthcare known as Servizio Sanitario Nazionale (SSN). The divided revenues are split into preassigned minimal “statutory benefits” packages (LEA) in accordance with the Ministry of Health. These “statutory benefits” packages (LEA) are for all residents in every region. What preassigned percentage is spent on in healthcare is determined by the regions. North and South Italy have different distributions of funds. Fifty five percent of fund in the North is spend on local care such as preventative and primary care and fifty percent is spent in the South. The North invests fifty percent of funds on hospital care while the South only uses forty five percent. The North spends less of their gross domestic product on healthcare (six and a half percent) than the South (nine and a half percent). In 2012, the gross domestic product spent on healthcare in Italy was seven percent with seventy percent of healthcare being public (TforG, 2016).
The SSN pays general practitioners depending on how many patients are on their service. The annual average income general practitioner is between EUR80,000 (USD107,000) and EUR120,000 (USD160,000). Prescription drugs are prescribed by physicians. Prescription drugs require a copay depending on the medication and how much money the patient makes. Prescription drugs are usually free for the poor. Drugs that are not prescription are not covered by SSN and must be paid for by the patient. Outpatient specialist appointments and diagnostic testing also require a copayment of about EUR 40 that is paid prior to the appointment or test. All conditions requiring a hospital stay or surgery are covered by public healthcare for all residents in public hospitals. Surgeries and hospitalization provided by public hospitals or by private hospitals who have agreements with the public health system (The Commonwealth Fund, 2016)
The ASL or hospitals in the SSN or private network who are contracted with the ASL provide outpatient specialist care. First the patient must be referred by their general practitioner and then they may choose either a public or private accredited hospital. Patients are not allowed to choose their specialist under SSN. Outpatient specialist visits are generally provided by self-employed specialists working under contract with the National Health Service. Specialists who have a contract with the National Health Service are paid an hourly rate and have regulations in regards to which patients they may see. Outpatient specialists who do not work for ASL or public hospitals may see private patients without any practice restrictions. Services at private hospitals are much more expensive than public (The Commonwealth Fund, 2016).
Practitioners who work in hospitals are salaried opposed to how General Practitioners are paid. Practitioners of ASL facilities are legally not allowed to provide care for patients in private hospitals. If a private patient is seen in a public hospital then an amount of the additional income is paid to the hospital. A flat budget is generally given to ASL run hospitals opposed to a diagnosis group related reimbursement plan. The flat budget includes all operating cost including practitioner’s salary. The ASL facilities that are teaching facilities are given extra money due to teaching having increased expenses. If an Italian resident is in need of financial assistance due to inability to care for themselves, they are given money from the National Pension Institute. The assistance amount is based upon their need and is usually EUR500 (USD714) per month (The Commonwealth Fund, 2016).
Trends
During 2015, hospitals were assigned as different level care facilities by the Ministry of Health. Base hospitals provide basic care such as an emergency room, general medicine and surgery, orthopedics, and testing as needed. Level one hospitals have the same amenities as base hospitals as well as birthing capabilities, pediatrics, cardiovascular critical care unit, neurology and psychiatric unit, oncology, ophthalmology, otolaryngology, and urology. Level three hospitals are equipped to for severely critically ill patients in addition to what base and level one facilities care for. Implementing different levels of care at faculties was done to improve quality. In 2017, vaccinations for all children up until age sixteen became mandatory and is part of the essential levels of care program (The Commonwealth Fund, 2016).
Health Policy
All Italian residents are provided with healthcare via a blended public and private system. All Italian citizens and registered aliens receive coverage. The inclusion for insurance is automatic once you are a citizen of Italy. Seventy seven percent of healthcare systems in Italy are public. Servizio Sanitario Nazionale (SSN) is the name of the public healthcare system (TforG, 2016). Private providers are for-profit or non-profit and collaborate with public ASLs and regional government to supplement health services. Thirty percenty Italian citizens have private health insurance (Allianz Care, 2018).
Access and Current Issues
Through the ASL, residents are established with a general practitioner. If any referrals are needed to a specialist or for diagnostic tests, the general practitioner sets them up. General practitioners are required to have office hours five days a week with a limit of fifteen hundred patients that may be seen. Patients have the autonomy to select a different general practitioner than the one they are assigned. If care is required during hours that are not the general practitioner’s office hours, emergency care at the hospital is available or an on call general practitioner. Based on the severity of the problem, the patient may have ot pay an additional fee to be seen for emergency care at the hospital (The Commonwealth Fund, 2016).
Waiting times for planned surgeries with public healthcare takes a few months to occur and a couple weeks with private healthcare. The length of time until surgery can be decreased if the matter is urgent or by choosing the “free market” option. The “free market” option is at public and private hospitals and consists of the patient paying an out of pocket fee. Another issue is that outcomes of care in different regions vary. The northern regions when compare to the southern regions are said to be of better quality. An example of this is that patients who needed interventions preformed within forty hours per national standards were only receiving it fifteen percent of the time in southern regions and fifty percent of the time in northern regions. The is resulting in more people moving to the northern regions (The Commonwealth Fund, 2016). Private insurance allows choice of providers and treatment at private hospitals. Waiting times for appointments are generally shorter. The facilities are nicer with hospitals having rooms that are equal to luxury hotels. Despite the nicer accommodations, healthcare is similar. Although the comfort and the quality of service from private hospitals are superior, the medical care is likely to be similar to that of public hospitals (Allianz Care, 2018).
References
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