Chapter 2

CEIS Health Report 2006
1.6 - The regional primary care agreements:
tools for real demand control?
Barrella A. 1 , Rebba V. 2
1.6.1 The reference context
The rising costs in the health system, linked partly to a growth in the demand for health
deriving from the increasingly felt need to maintain a high quality of life, but also to the
presence of a large proportion of elderly people in the population characterized by the
presence of chronic and degenerative pathologies, has drawn the attention of both national
and regional health programming to the problem of controlling expenditure in a financial
context of poor resources, intervening on both the supply and demand side.
Demand control in a public health system can be achieved via different types of tools,
both traditional and innovative, which permit management of rising expenditure in a costeffective
way vis-à-vis a low level of public resources. The tools adopted so far have been
mainly of a direct nature and aimed at controlling independently-expressed demand (i.e.
without the referral of a health professional) via cost-sharing measures, with rationing
mechanisms (waiting lists and times) or health education of the population, but increasing
attention is being paid to indirect tools, used to regulate the demand induced by the
health professionals by means of appropriate forms of supply organization via which the
demand can be directed and selected, such as the definition and implementation of guidelines
and diagnostic-therapeutic paths, the strengthening of primary care and definition
of priority criteria to manage waiting lists (Muraro e Rebba, 2004).
1.6.2 The tools for strengthening primary care
Focusing attention on the strengthening of primary care (which also includes the implementation
of guidelines and diagnostic-therapeutic paths), with a view to future overall
sustainability of the system, the general practitioner undoubtedly plays an important part
and is increasingly required to act as a driving force for the change taking place in the primary
care services, in his/her role of intercepting the demand for health and controlling
the care paths via appropriate patient management and direct participation in formulation
of the services delivered 3 . The key role assigned to the GP means that an analysis of the
primary care agreements reached at both national and regional level is essential in order
to assess the tools available for contributing to real control of demand, understood in the
broadest sense of identification and appropriate satisfaction of needs, given the structure
of the supply.
1 Pfizer Italia S.r.l.
2 Department of Economics, University of Padua.
3 In addition to being involved in the health education of the population (direct demand control tool).
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