Chapter 2

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Support is thus given to the hypothesis that the explanation of the variation in rates of hospitalization is to be sought in the structure of the supply rather than in the needs of the population. Passing to day hospitals, the rate of day-hospitalization in Italy overall is 61,74 per thousand population, starting at 71,40 per thousand at birth and ending at 98,53 per thousand at age 75 and over. For the first year of life one finds a markedly irregular geographical distribution (as for the ordinary regime) with a great variation in the hospitalisation rate from one Region to another. The highest rates are in Liguria (188,02 per thousand) and Sicilia (140,62), followed by Lazio (102,17). These Regions also have the highest rates for other age classes. Puglia and Val d’Aosta are the Regions with the lowest proportion of day-hospitalization (in the first year of life 9,36 and 13,05 per thousand population respectively). Puglia also has the lowest rates of day hospitalization for other age bands. Day-hospitalization rates rise with the 65-74 age class, then decreasing or remaining constant at age 75+ (Figure 6). Figure 6 - Hospitalization rates – Acute cases in day hospital (figures per thousand population) – age zero and 75+ Hospitalization rates (acute cases DH) 200,00 180,00 160,00 140,00 120,00 100,00 80,00 60,00 40,00 20,00 0,00 Abruzzo Piemonte Val d’Aosta Lombardia Bolzano Trento Veneto FVG Liguria Emilia The very great variation encountered again confirms that availability of services is the determining factor and that in the case of hospitalization in the day-hospital regime this requires planning for restructuring of the care network. In conclusion, analysis of hospitalization rates reveals a still incomplete and widely variable rationalization of supply, which determines differences in access to hospital services, raising questions regarding both efficiency and equity. Toscana Umbria Regions Marche [89] Lazio Molise Campania Puglia Basilicata Calabria 0 Sicilia Sardegna 75+ CEIS Health Report 2006 Italia
CEIS Health Report 2006 1.5.5 Absorption of resources standardized by age: the case mix To free the analysis of effects deriving from hospitalization rates, the distribution of mean “costs” by age group in the individual Regions has been calculated, standardising against the mean “costs” for the 25-44 age class; this class was chosen as being generally close to the total Regional mean. For acute cases hospitalized in the ordinary regime, hospitalizations at age 0 cost on average 100,1% of those of the reference class, whereas for age 75+ “costs” amount to 152,5%. As might have been expected, therefore, the elderly generally have “more complex” cases. However, in looking at the aggregate data, one must note that the relative “cost” at birth ranges from 185,3% in Emilia Romagna to 86,5% in Molise. In the last age class (over 75) Trento province has an average relative “cost” of 173,5%, followed by Val D’Aosta (172,0%) and Toscana (169,7%); at the other extreme Sardegna has a relative “cost” of only 136,8%, followed by Molise (138,8%) and Calabria (146,2%) (Figure 7). Figure 7 - Average “cost” per person hospitalized (ordinary regime) Age zero and 75+ Average “costs” per person hosspitalized (RO) 200,0% 180,0% 160,0% 140,0% 120,0% 100,0% 80,0% 60,0% 40,0% 20,0% 0,0% Abruzzo Calabria Lazio Sardegna Val d’Aosta Veneto Piemonte For day hospitalization, relative costs range from 57,3% at age zero to 123,1% for the over 75 class. At age 0 the range runs from a relative “cost” of about 85,0%in Molise to 31,8% in Piemonte. In the 75+ class, Toscana is at 137,9%, whereas Emilia Romagna and Lombardia stand at 90,8% and 91,4% respectively (Figure 8). [90] Lombardia Bolzano Trento F.V.G. Liguria Regions Emilia Toscana Umbria Marche Molise Campania Puglia 0 Basilicata Sicilia 75+ Italia
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CEIS Health Report 2006 Management
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CEIS Health Report 2006 Management
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Index Report Presentation by Pagane
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1.6 - The Regional Primary Care Agr
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Chapter 3 - Efficiency 3.1 - The Ef
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3.8 - Private Health Insurance and
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Ceis - Sanità Report presentation
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Warning The figures in the volume f
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CEIS Health Report 2006 stantial, i
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CEIS Health Report 2006 If, therefo
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CEIS Health Report 2006 Cross-check
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CEIS Health Report 2006 over € 6.
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CEIS Health Report 2006 made; final
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CEIS Health Report 2006 Although th
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CEIS Health Report 2006 Aside from
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CEIS Health Report 2006 Regulations
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CEIS Health Report 2006 especially
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CEIS Health Report 2006 The Second
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CEIS Health Report 2006 2.5 - Imple
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CEIS Health Report 2006 2.5.3 Shift
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CEIS Health Report 2006 Table 1 - P
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CEIS Health Report 2006 and, conseq
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CEIS Health Report 2006 Grant whose
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CEIS Health Report 2006 Generally s
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CEIS Health Report 2006 Scheme for
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3.1 - The efficiency of Regional He
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Table 2 - LEA Financing REGIONS HOS
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• Campania, with strong financial
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[163] CEIS Health Report 2006
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hospital stays has reduced the aver
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treated varies greatly. The highest
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CMS = f(COST, CMP, PL, RC, DM , PME
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formance, implying an increase in a
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3.3 - The National Health System Ev
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3.3.3 Cooperation with the Regional
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the contract conditions are previou
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Consequentially, in order to avoid
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order through the MEPA) numbered 14
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3.4 - Strengthening the capacity fo
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for designing and governing organiz
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the hierarchical and management rol
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tions may appear and disappear, the
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lop, rather than a variable to be c
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units along business lines were unq
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cooperation to achieve the developm
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However, to manage a multi-site hos
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Figure 2 - AVS Strategy map • con
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cialties, but what sets them apart,
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nistically or quantitatively. Hence
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portant for healthcare industry, as
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tor is that General Managers usuall
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cation of the ABC and, in general,
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● Kaplan R, Norton D (1992), “T
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3.7 - The management of healthcare
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Table 1 - Pathway for st elevated a
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[217] CEIS Health Report 2006 Table
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Vaginal childbirth Some synthesis i
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Politiche sanitarie, marzo-aprile.
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dental work, the purchase or rental
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2. We might suppose that the state
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● OECD (2004), “Towards High -
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4.1 - Equity in the italian healthc
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Table 2 - Association indexes betwe
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4.1.5 Structure of health expenditu
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Table 9 - Regional distribution of
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strophic payments; moreover, the se
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● Doglia M, Spandonaro F, “Il p
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CEIS Health Report 2006 (i represen
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CEIS Health Report 2006 sence of di
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CEIS Health Report 2006 -0,0030, wh
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CEIS Health Report 2006 Although co
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5.1 - The median age at death for m
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causes and the median age at genera
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in the South and Islands, not only
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5.2 - Analysis of avoidable deaths
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population of Italian citizens acco
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We wish to underline the mortality
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Diagram 4 - % composition of years
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5.2.4 Comments The results of the a
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among whites and blacks,1979-1989
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Figure 1 - Division % of the quota
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Figure 3 - Pharmaceutics expenditur
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Table 3 - Gross fixed investments i
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Table 4 - Share of medical device w
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age dimension of enterprises (90 em
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BOX 2: National Medical Device Clas
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maceutiche in Italia (1997-2001)”
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5.4 - Mobility of italian patients
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Authority (ASL) will be charged for
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43.950.716,00. At this stage, if yo
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esting data are certainly provided
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have carried out economic and stati
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[295] CEIS Health Report 2006
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✔ DE POUVOURVILLE GÉRARD Researc
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✔ MENNINI FRANCESCO SAVERIO Degre
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✔ SCHWEIGER ARTURO Health Economi
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Chapter 2

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