Italian health care reform

It is remarkable how health care systems, created over decades and influenced by very different cultures exhibit similar problems. Most health care systems are compartmentalised with managers at margins responding to perverse incentives and seeking to shift patients and costs onto rival organisations. Decision makers behave selfishly, considering the welfare of their own organisations rather than those of the health care system as a whole, and in the absence if evidence about the cost-effectiveness of competing treatments. Not only are the problems similar across health care systems, their resolution by politicians is also tackled in ways which are common. Thus in Italy the language and reforms of the UK NHS is affecting policy. The UK management reforms of the mid-1980s are now being translated into Italian innovations which include new contracts and performance related policy. The Italian GP contract has been altered and there is a desire to improve the efficiency of the supply side. The defects of the Italian health care system and their reform to produce health gains at lower cost are not well informed by evidence and, like the UK reforms, policy often appears to be conceived hastily and poorly evaluated. The lessons to be learnt from this paper are that many of the problems of health care systems with very different structures are common and there are few proven methods of resolving them.reform, Italy

Il mercato dei dispositivi per stomia in cinque paesi europei: lezioni per l’Italia

Aim of the present study is to analyze the international market of the ostomy devices in Italy, France, Germany, U.K. and Denmark. The ostomy systems are technologically mature devices, and the more interesting market developments are about innovative modality of distribution and patients technical support, like home distribution. For every country it has been applied a common pattern, based on four aspect of the ostomy devices market: 1. the legislative aspect; 2. the prescription procedure; 3. the different models of distribution; 4. the competitive systems of pharmaceutical industry. All the data in this study has been galthered through relevant literature and interviews with the area operators. The ostomy devices are repayable against medical prescription in all the studied countries; significant legislative differences are registered in the repayment prices determination. For all the studied countries, in the decisional process related to the choice of one or another device, the essential role is played by the ostomy hospital nurse, that advises the patient immediately after the surgery. Finally, the more significant examples to innovate purchase and distribution process of ostomy devices in Italy comes from Denmark and U.K., where the home distribution is already available and it is working

Analisi comparativa del mercato dei dispositivi per incontinenza in cinque paesi europei

The aim of the paper is to compare and valutate the market of the incontinence devices in five European countries: Italy, France, Germany, U.K. and Denmark. We chose incontinence devices because they are strictly connected with the development of the home delivery. France, Germany and U.K. has been analysed for their politic and territorial importance, while Denmark has been considered for its home assistance system. A common pattern has been applied in every country: first of all there is a general outline of the legislative aspect of the incontinence devices, then the study presents prescription procedure and the different models of distribution. Finally, it shows the competitive systems of the pharmaceuticals industry in every single country. The necessary information has been gathered through relevant literature and interviews with the area operators. The incontinence devices are repayable in all the studied countries, except from France. Every country has different health system (Italy, U.K and Denmark had a public health system; France and Germany has a mutualist health system). There isn’t an evident correlation between the type of the health system and the market of the incontinence devices

I costi di struttura dei servizi neurologici in Italia

The present study aimed to evaluate the mean unit cost of neurological services, broken down by type of output: hospital day of stay, day hospital day and outpatient consultation. The analysis concerned five neurological services (four hospital wards and one clinic), located in the North and Centre of Italy, selected among the 16 participants of the EPICOS (Epilepsy Costs) project. The most important result of this study was to estimate a baseline unit cost which can be used for assessing the total cost of a neurological disease. The study was conducted according to the full cost method. However, drugs and examinations were not included in this analysis, assuming that these costs are tightly related to the specific neurological pathology considered. Personnel was the most relevant component of total cost, accounting for 76% for outpatient services, 66% for admissions and 54% for day hospital. The estimated unit cost was L.395,000 for a hospital day of stay, L.527,000 for a day hospital day, and L.89,000 for an outpatient consultation

Western European markets for biosimilar and generic drugs: worth differentiating

n/

Efficienza tecnologica e produttiva delle strutture trasfusionali in Italia

In all the developed countries the methods of blood collection and production are relevant subjects for the pharmacoeconomics studies, because of their health and economic implications related to the health policies in this area. The “blood market” rappresents an area where the sanitary items, the economic items and also the ethic items must be broached at the same time; therefore it can be considered emblematic. By this situation arises Progetto CO.R.SA. (COsti Raccolta SAngue), a project for estimating productivity and cost for a representive sample of italian trasfusional structure (ST). The study is supported by Società Italiana di Medicina Trasfusionale e Immunoematologia (SIMTI). In Italy there are about 380 ST, but only 30 ST resulted suitable for the study. The analysis investigates six rates concerning: a) wastes; b) technological efficiency; c) personnel productivity. The present work describes only the informations on ST organization and production, delaying the results about costs to a specific further report

Utilities and QALYs in health economic evaluations: glossary and introduction

n/

Il costo medio per tipologia di prestazione nei centri trasfusionali

In Italy the collection, validation and separation of blood and its derivatives for transfusional interventions are carried out by some 380 transfusional centers (TCs), mainly located within greater health care structures. The aim of the CORSA (Costi Raccolta Sangue) study was to furnish an estimate of the mean cost of the main transfusional services on a sample of the Italian TCs. Of the centers contacted, only 13,3% were able to deliver the unit costs necessary to perform the full-cost, fully-allocated analysis conducted. Of the three services examined (apheresis of plasma and platelets, whole blood collection), the selective collection of thrombocytes resulted the most expensive, as opposed to whole blood collection. The mean cost of a erythrocyte, plasma and platelet unit resulted of 17,7, 21,6 and 89,8 •, respectively, although the variation among centers was substantial. To main conclusions can be drawn by the CORSA study. First, the very low percentage of TCs able to provide the necessary data for a complete economical analysis highlights an important delay in the modernizing process of health care management, started in 1992 with the aim to ameliorate resource allocation. Second, the study was not able to establish a relationship between production volume and production cost, indicating the absence of scale economy features in transfusional processes

Durata e costo delle visite in medicina generale: il progetto DYSCO

In Italy, general practitioners (GPs) operating within the National Health Service (NHS) are paid according to the number of patients followed, without relation to the number of visits performed. This means that, from a theoretical point of view, the marginal cost of an adjunctive medical examination equals to zero. Since this view is clearly little realistic, in this paper we expose a methodological approach to estimate the real cost of a GP visit, starting from data collected in the DYSCO study, a national survey on the medical costs of dystimia in Italy. 46 GPs were asked to record the number and duration of ambulatory and domiciliar visits, along with the time spent in administrative tasks, during 4 weeks, each randomly chosen within a season (spring, summer, autumn, winter). In order to assign a monetary value to each visit, the total fee reimbursed by the NHS to a GP was divided by the total time spent on work, and then again by the number of visits conducted during this time. The calculations performed revealed that the mean duration of a ambulatory visit amounts to about 10 minutes, while a domiciliar visit (including travelling time) lasts almost the double. An interesting result was that summer visits have significantly longer duration than the mean, and consequently cost more. The mean cost of a GP’s ambulatory visit resulted about 12 Euro; a domiciliar visit costs almost 23 Euro. The times and costs calculated in this study are consistent with other calculations performed by other authors in Europe and Italy, confirming the appropriateness of the employed methodology