Chapter 2

ceutical policies. To encourage efficiency, they should be delegated to the local level,
abandoning the claim to manage the system with excessively simple rules such as the
13% cap.
A similar argument can be made for the policies aimed to rationalize hospital admissions,
at present based on cutting bed places.
One first simple, but not obvious, comment is that closing beds does not necessarily
imply a reduction in related costs, primarily, those for employees but also fixed costs for
equipment etc.
It then seems important to check whether the progressive reduction in bed places and
the, at least partial, success in reducing the costs of “Hospital Care”, really portend a
rationalization of the network, or if the savings are fundamentally financial.
The quantitative picture appears rather complex (see chapter 1.5, Rocchetti,
Spandonaro). We find, in fact, that hospitalization rates (standardized for age) vary from
Region to Region by 300% (even more for day hospitals, rehabilitation and long term
hospitalization), with very different case mixes (varying by 1,5 times in terms of their associated
tariffs).
It seems there are few doubts about the persistence of situations where recourse to the
hospital is not attributable to demographic or epidemiological factors.
Consequently, it is no surprise that the curve of resource absorption against age may be
very different for the population of one Region compared with another. In some age classes,
we find a difference in absorption of resources, between Regions, of about 250%.
Furthermore, to the differences in hospital admission, we should add extremely variable
tariff levels. The maximum differences in mean per age class reach 60%.
Undifferentiated central policies (for example those oriented to fix the maximum number
of regional bed places per inhabitant) seem unable to provide incentives for effective
rationalization and at times may be a source of additional risk of inappropriateness and
inefficiency. In fact, use of the tariffs leverage for financial reasons (compliance with funding
ceilings) predominates over their use to regulate the quality or quantity of services
provided.
By exclusion, one has to admit that the differences in performance found, justify a presumption
of the existence of widespread inappropriateness.
In short, we found a demand largely conditioned by the supply, following a self-referencing
model typical of many environments in the Italian National Health service. To overcome
the problem, in terms of management of the system, it therefore seems desirable
to concentrate both on monitoring recourse to the hospital and on staffing, abandoning
regulation of the supply of beds.
This hospital policy option is likewise corroborated by the assessment of significant
levels of (in)efficiency in hospital organizations (see chapter 3.2, Fioravanti, Polistena,
Spandonaro).
The analysis, which has now reached its third annual revision, makes it possible to state,
with ever greater conviction, that there are significant problems in terms of both funding
and efficiency. The cost per homogeneous unit of admission, analysed in 96 public hospital
organizations, varies by 300% from a minimum of about € 2.000 per DRG point to
[25]
CEIS Health Report 2006