Chapter 2

More documents

Recommendations

Info

Contributions relative to various European and non-European countries that are presented in this volume (see chapters 2.1-2.6) demonstrate how the formation of deficits is a substantially common problem: perhaps with the exclusion of the Australian case (where regulations tend to ration services) and the Dutch one (where insurance premiums evolve adapting themselves to expenditures). At the same time, it seems that the matter is not internationally perceived as central to the control of expenditure: discussions on how to determine an acceptable and congruous level of expenditure are in the forefront. Domestic sensibility towards budget balance can probably be explained by the peculiar Italian debt; but consider that its trail of controversies over deficit attribution entails delays in payments and the creation of implicit costs. Moreover, the statistical evidence stemming from models, in some way, seems to justify underestimation of the heath care burden as a public policy, considering both that expenditure tend to adapt to resources made available, and the multiplying effect on overall expenditure. In addition to financial aspects, a bipartisan will to refinance the sector emerges. This confirms and accelerates a trend, which has been ongoing for at least the past five years. The health system has paid an important contribution to the recovery of the Italian debt and to Italy’s “entrance” into Europe: up to the 1995/1996 biennium, when funding and expenditures of the sector had their historical minimum (respectively 5,1% and 5,2% of the GDP). The following decade brought the level of expenditure back to that of 1991 (6,4%), although funding was more precautionary. After a decade and in the presence of a secular increasing trend in total health expenditures, the scenario described by the model seems to be substantially acceptable, as it brings public health expenditure to between 6,8%-7% of the GDP: a figure which is an average of the international ones. Should the budget constraint not allow further growth in public health funding, an equity problem would in any case arise: and precisely how to transform the relevant share of out of pocket expenses into insured ones, through forms of integrated coverage, containing some elements of solidarity. The process may undoubtedly be facilitated in presence of more efficiency and appropriateness of services provided (see other contributions in the volume): that is releasing funds which are particularly useful for re-qualification and adjustment procedures needed to face with a large geographical inequality. Referring back to other contributions in the volume for an in-depth analysis of the levels and causes of (in)efficiency and (in)appropriateness, it would be worthwhile to recall that the funds that would eventually be released are already “reserved”; in the sense that they have a natural destination towards necessary improvements in the quality of services. Although the Italian SSN lacks a systematic supervision over the quality of its services, it is a common opinion that there are broad and mandatory margins for improvements: for example, by IT, building investments, etc. The Budget Act also takes note of this, since it contains a re-financing of the Law 88/1988 programme for health facilities. In conclusion, the gap between funding and expenditures seems to be slightly reduced and, in any case, the question seems more a problem of deficit administration than absolute level of the same; at the same time, the subject of contributions that public health sector should pay towards the reduction of the Italian debt, seems to be still unsolved (in the sense that it remains implicit). It is evidently a problem of priorities that must be faced, while recognizing that there is a strong link between the various welfare components: first and foremost between Pensions (financial benefit) and Health (benefit in kind). [71] CEIS Health Report 2006
CEIS Health Report 2006 1.4 - Pharmaceutical policies in Italy Barrella A. 1 , Polistena B. 2 , Ratti M. 2 , Spandonaro F. 2 1.4.1 The growth of the pharmaceutical expenditure The total national pharmaceutical expenditure – both public and private – amounting to €19.459 million in 2005 3 , was obtained through a 1,4% increase compared to the previous year, determined by a 6,3% 4 increase of private expenditure and by a 0,6% reduction of public expenditure 5 . Diagram 1 – Total Italian Pharmaceutical Expenditure over the 1985-2005 period Milions € 16.000 14.000 12.000 10.000 8.000 6.000 4.000 2.000 0 1 Pfizer Italia Srl. 1985 1986 1987 1988 1989 2 CEIS Sanità, Faculty of Economics, University of Rome “Tor Vergata” . 1990 1991 1992 3 See OsMED (2006). L’uso dei farmaci in Italia. Rapporto nazionale anno 2005, Rome, June 2006. 4 Deriving from the consistent increase of 35,2% of the private expenditure for reimbursable drugs (class A drugs), but also for the increase of pharmaceutical expenditure of class C drugs (+2,2%) and of OTC drugs (+3,5%). 5 This can be almost totally explained by price cutting (-3,4%), but it also depends on the mix-effect trend (-1,1%), while an increase (+4,0%) has continued to be recorded on the quantity of prescribed drugs. [72] 1993 Source: our study based on OsMED data Public Pharmaceutical Expenditure (Mil. €) Private Pharmaceutical Expenditure (Mil. €) 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Page 1 and 2:
CEIS Health Report 2006 Management
Page 3 and 4:
CEIS Health Report 2006 Management
Page 6 and 7:
Index Report Presentation by Pagane
Page 8 and 9:
1.6 - The Regional Primary Care Agr
Page 10 and 11:
Chapter 3 - Efficiency 3.1 - The Ef
Page 12 and 13:
3.8 - Private Health Insurance and
Page 14:
Ceis - Sanità Report presentation
Page 17 and 18:
Warning The figures in the volume f
Page 19 and 20: CEIS Health Report 2006 stantial, i
Page 21 and 22: CEIS Health Report 2006 If, therefo
Page 23 and 24: CEIS Health Report 2006 Cross-check
Page 25 and 26: CEIS Health Report 2006 over € 6.
Page 27 and 28: CEIS Health Report 2006 made; final
Page 29 and 30: CEIS Health Report 2006 Although th
Page 31 and 32: CEIS Health Report 2006 Aside from
Page 33 and 34: CEIS Health Report 2006 Regulations
Page 35 and 36: CEIS Health Report 2006 especially
Page 38: Chapter 1 Health expenditure and fu
Page 41 and 42: CEIS Health Report 2006 The questio
Page 43 and 44: CEIS Health Report 2006 Table 1 - T
Page 45 and 46: CEIS Health Report 2006 Figure 3 -
Page 53 and 54: CEIS Health Report 2006 ciated with
Page 55 and 56: CEIS Health Report 2006 ● OECD (2
Page 59 and 60: CEIS Health Report 2006 the phenome
Page 61 and 62: CEIS Health Report 2006 Table 3 - R
Page 63 and 64: CEIS Health Report 2006 The indicat
Page 65 and 66: CEIS Health Report 2006 References
Page 67 and 68: CEIS Health Report 2006 All the var
Page 69: CEIS Health Report 2006 Diagram 1 -
Page 73 and 74: CEIS Health Report 2006 % Pharmaceu
Page 75 and 76: CEIS Health Report 2006 The second
Page 77 and 78: CEIS Health Report 2006 tion of res
Page 79 and 80: CEIS Health Report 2006 Table 4 - R
Page 81 and 82: CEIS Health Report 2006 The variati
Page 83 and 84: CEIS Health Report 2006 1.5 - The r
Page 87 and 88: CEIS Health Report 2006 southern Re
Page 89 and 90: CEIS Health Report 2006 1.5.5 Absor
Page 91 and 92: CEIS Health Report 2006 For day hos
Page 93 and 94: CEIS Health Report 2006 There is co
Page 95 and 96: CEIS Health Report 2006 1.6 - The r
Page 97 and 98: CEIS Health Report 2006 the Primary
Page 99 and 100: CEIS Health Report 2006 Table 1 - T
Page 101 and 102: CEIS Health Report 2006 • “phys
Page 103 and 104: CEIS Health Report 2006 1.7 - Evolu
Page 105 and 106: CEIS Health Report 2006 As can be o
Page 107 and 108: CEIS Health Report 2006 Another int
Page 109 and 110: CEIS Health Report 2006 Some signif
Page 111 and 112: CEIS Health Report 2006 1.7.5 Concl
Page 113 and 114: CEIS Health Report 2006 [114]
Page 116: Introduction Public deficit in the
Page 119 and 120: CEIS Health Report 2006 The cumulat
Page 121 and 122:
CEIS Health Report 2006 tegies of i
Page 123 and 124:
CEIS Health Report 2006 gest that t
Page 125 and 126:
CEIS Health Report 2006 increase of
Page 127 and 128:
CEIS Health Report 2006 increase in
Page 129 and 130:
CEIS Health Report 2006 [130]
Page 131 and 132:
CEIS Health Report 2006 It is also
Page 133 and 134:
CEIS Health Report 2006 shifting be
Page 135 and 136:
CEIS Health Report 2006 year (AIHW
Page 137 and 138:
CEIS Health Report 2006 cost of the
Page 139 and 140:
CEIS Health Report 2006 The Second
Page 141 and 142:
CEIS Health Report 2006 2.5 - Imple
Page 143 and 144:
CEIS Health Report 2006 2.5.3 Shift
Page 145 and 146:
CEIS Health Report 2006 Table 1 - P
Page 147 and 148:
CEIS Health Report 2006 and, conseq
Page 149 and 150:
CEIS Health Report 2006 Grant whose
Page 151 and 152:
CEIS Health Report 2006 Generally s
Page 153 and 154:
CEIS Health Report 2006 Scheme for
Page 156 and 157:
3.1 - The efficiency of Regional He
Page 158 and 159:
Table 2 - LEA Financing REGIONS HOS
Page 160 and 161:
• Campania, with strong financial
Page 162 and 163:
[163] CEIS Health Report 2006
Page 164 and 165:
hospital stays has reduced the aver
Page 166 and 167:
treated varies greatly. The highest
Page 168 and 169:
CMS = f(COST, CMP, PL, RC, DM , PME
Page 170 and 171:
formance, implying an increase in a
Page 172 and 173:
3.3 - The National Health System Ev
Page 174 and 175:
3.3.3 Cooperation with the Regional
Page 176 and 177:
the contract conditions are previou
Page 178 and 179:
Consequentially, in order to avoid
Page 180 and 181:
order through the MEPA) numbered 14
Page 182 and 183:
3.4 - Strengthening the capacity fo
Page 184 and 185:
for designing and governing organiz
Page 186 and 187:
the hierarchical and management rol
Page 188 and 189:
tions may appear and disappear, the
Page 190 and 191:
lop, rather than a variable to be c
Page 192 and 193:
units along business lines were unq
Page 194 and 195:
cooperation to achieve the developm
Page 196 and 197:
However, to manage a multi-site hos
Page 198 and 199:
Figure 2 - AVS Strategy map • con
Page 200 and 201:
cialties, but what sets them apart,
Page 202 and 203:
nistically or quantitatively. Hence
Page 204 and 205:
portant for healthcare industry, as
Page 206 and 207:
tor is that General Managers usuall
Page 208 and 209:
cation of the ABC and, in general,
Page 210 and 211:
● Kaplan R, Norton D (1992), “T
Page 212 and 213:
3.7 - The management of healthcare
Page 214 and 215:
Table 1 - Pathway for st elevated a
Page 216 and 217:
[217] CEIS Health Report 2006 Table
Page 218 and 219:
Vaginal childbirth Some synthesis i
Page 220 and 221:
Politiche sanitarie, marzo-aprile.
Page 222 and 223:
dental work, the purchase or rental
Page 224 and 225:
2. We might suppose that the state
Page 226:
● OECD (2004), “Towards High -
Page 230 and 231:
4.1 - Equity in the italian healthc
Page 232 and 233:
Table 2 - Association indexes betwe
Page 234 and 235:
4.1.5 Structure of health expenditu
Page 236 and 237:
Table 9 - Regional distribution of
Page 238 and 239:
strophic payments; moreover, the se
Page 240:
● Doglia M, Spandonaro F, “Il p
Page 243 and 244:
CEIS Health Report 2006 (i represen
Page 245 and 246:
CEIS Health Report 2006 sence of di
Page 247 and 248:
CEIS Health Report 2006 -0,0030, wh
Page 249 and 250:
CEIS Health Report 2006 Although co
Page 252 and 253:
5.1 - The median age at death for m
Page 254 and 255:
causes and the median age at genera
Page 256 and 257:
in the South and Islands, not only
Page 258 and 259:
5.2 - Analysis of avoidable deaths
Page 260 and 261:
population of Italian citizens acco
Page 262 and 263:
We wish to underline the mortality
Page 264 and 265:
Diagram 4 - % composition of years
Page 266 and 267:
5.2.4 Comments The results of the a
Page 268 and 269:
among whites and blacks,1979-1989
Page 270 and 271:
Figure 1 - Division % of the quota
Page 272 and 273:
Figure 3 - Pharmaceutics expenditur
Page 274 and 275:
Table 3 - Gross fixed investments i
Page 276 and 277:
Table 4 - Share of medical device w
Page 278 and 279:
age dimension of enterprises (90 em
Page 280 and 281:
BOX 2: National Medical Device Clas
Page 282 and 283:
maceutiche in Italia (1997-2001)”
Page 284 and 285:
5.4 - Mobility of italian patients
Page 286 and 287:
Authority (ASL) will be charged for
Page 288 and 289:
43.950.716,00. At this stage, if yo
Page 290 and 291:
esting data are certainly provided
Page 292 and 293:
have carried out economic and stati
Page 294 and 295:
[295] CEIS Health Report 2006
Page 296 and 297:
✔ DE POUVOURVILLE GÉRARD Researc
Page 298 and 299:
✔ MENNINI FRANCESCO SAVERIO Degre
Page 300:
✔ SCHWEIGER ARTURO Health Economi
show all

Chapter 2

Create successful ePaper yourself

Delete template?

Save as template?