Chapter 2

CEIS Health Report 2006
3.2 - The efficiency of hospital organizations
Fioravanti L. 1 , Polistena B. 1 , Spandonaro F. 1
3.2.1 Introduction
This paper aims to provide an evaluation of the efficiency of Italian hospital organizations.
Although the topic is of obvious importance, to understand its many impacts one has to
remember that moving the “core” of health care from hospital to “territory” has for many
years been a central stated aim of health policy and that its attainment requires a release
of resources in the direction of primary care, though without this implying any decline
in hospital effectiveness. This is an ambitious aim that obviously can only be pursued
through gains in efficiency.
The effects of this health policy decision are tangible. One notes a progressive increase
in the proportion of resources allocated to “territorial care” and a parallel reduction in that
assigned to “hospital care”, current target allocations being 49,5% for the first and
45,5% for the second. In the various Regions, the process of transfer of resources has
in fact begun, though slowed by considerable inertia, particularly in the southern
Regions. According to the cost monitoring data disseminated by the ASSR, the “hospital
share” has been reduced to percentages ranging from 43,8% in Emilia Romagna (thus
even lower than the indicated target) to 53,8% in Valle D’Aosta.
The cost of hospital care nevertheless, according to ISTAT (National Institute of
Statistics), amounts to € 44,9 billion, or 51,7% of total expenditure.
It must also be kept in mind that by convention the heading “hospital care” does not
include every form of residential care, since residential health care for the elderly, hospices
etc. are classified as “territorial care”.
The problem of efficiency therefore relates primarily to care for acute cases which, in
dimensions and costs, account for the largest part of the “hospital care” classification.
Then, remembering that the question of efficiency is at the centre of concern in health
policy largely because of the effect of rising costs on public health care systems, one can
justify the focus of this paper on directed operated public hospitals, especially those that
have been given the status of boards with entrepreneurial autonomy, in consideration of
both complexity and importance.
The legislator addressed this class of hospital in the reform of 1992/1993, providing, at
least in the original form of the legislation, for financing on the basis of the services rendered
(by DRG Diagnosis Related Group).
This concept of payment, even though it has largely remained on paper (see chapter 3.1,
Fioravanti, Spandonaro), has certainly had a profound influence on the system of hospital
care, as it has been pointed out in preceding papers 1 : the progressive shortening of
1 CEIS Sanità – Faculty of Economics, University of Rome “Tor Vergata”.
2 See Fioravanti L., Ratti M., Spandonaro F. (2005).
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