Chapter 2

CEIS Health Report 2006
especially in the centre-south; analogically for hospital services there still exist enormously
different levels of admission rate, with tariff policies that are more concentrated
on the objective of financial short-term “savings” rather than on the quality of services;
• Moreover, hospitals cannot be rationalised if there lacks the development of suitable
primary assistance: despite the trend to link general practitioner incentives to outcomes,
it seems a care model centred on patients needs has still to be implemented;
■ These sectors need to develop models and benchmarks that take into account the real
needs of citizens, ones that discourage inappropriateness and promote quality, following
the pay-per-performance logic;
• At the firms level, there is a growing attention to clinical pathways, although a coordinated
system of administration capable of exploiting such information at a strategic level
is still not in place; a hybrid managerial system is assumed, where budget and balanced
scorecard converge, albeit often with functions that are merely communicative;
• Rationalisation of procurement is also of growing importance; here the role of CONSIP
should be clarified, in the light of the proliferation of centralised Regional procurement
agencies;
• A critical element of rationalisation is also the organisational aspect: this field demonstrates
the risk of having innovations of form rather than of substance, namely falling
back upon a juridical-formal logic;
• In the presence of explicit indications regarding the necessity to rationalise at the macro
level (i.e. separation between purchaser and provider) and even at the micro level (i.e.
procurement, staff level, etc.), regulations often tend to concentrate on the area in-between
(interventions on “hospitals”, on “specialists care”, etc.), namely that identified by
type of supply, revealing a typically auto-referential logic;
■ New organisational models and rationalisation logics should be shifted towards the
demand, choosing the most efficient and appropriate options (in an evidence-based framework)
in order to tackle the different needs of the various groups of citizens: women,
elderly, chronically-ill, etc.;
• From the equity point-of-view, we should address the hard core represented by the
poor, impoverished and also by some of the families subjected to catastrophic payments:
their number is substantially stable over time, which only goes to prove the inefficiency
of interventions to date;
• Lump-sum co-payments have a potentially unfair effect, especially for the poorest
population brackets;
• Old-age is a very strong catalyst for impoverishment risks;
• Dental care and LTC (long-term care) are the uncovered areas which present most risks
to families;
■ We observe also inequality of access, in the sense of a different and potentially inappropriate
use of services depending on socio-economic status;
■ The above only goes to prove that there is urgent need for a general renewal of the
exemption mechanism, linking it to the household capacity to pay;
■ There is also proof that the present system of capitation, used to allocate resources to
Regions, which identifies age as its sole substantial need factor, should be reconsidered
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