Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>KCE</strong> Reports 1771<br />
8.4.5. After-hhours<br />
care in Itaaly<br />
Items<br />
Affter-Hours<br />
Primaary<br />
Care<br />
Expert(s)<br />
Prof. Massimiliaano<br />
Panel<strong>la</strong><br />
interviewed<br />
Università degli<br />
Studi del Piemonte Ori<strong>en</strong>tale O "Amedeo Avogadro"<br />
Dipartim<strong>en</strong>to di Medicina Clinica e Sperim<strong>en</strong>tale<br />
Via So<strong>la</strong>roli 17, , 28100 Novara<br />
Italia <br />
Ufficio +3903211660635(682)<br />
Fax +3903216220421<br />
Mobile +3933888109442<br />
<br />
e-mail panel<strong>la</strong>@@med.unipmn.it<br />
Literature base National and international<br />
publication ns on the topic of afterr-hours<br />
care in Italy<br />
Characteristics off<br />
Popu<strong>la</strong>tion of 57,5<br />
million (2004)<br />
the health system Italy operates a universal, tax-funded d health system modeled<br />
after the British NHHS.<br />
with relevance to While the c<strong>en</strong>trral<br />
governm<strong>en</strong>t determ mines the required minnimum<br />
b<strong>en</strong>efit packagge<br />
(which includes hoospital<br />
and physician sservices<br />
and some preescription<br />
drugs) and mostly<br />
after-hours care controls the disstribution<br />
of tax rev<strong>en</strong>u ue, responsibility for thhe<br />
organization and deelivery<br />
of health servicces<br />
is left to the 20 reggions.<br />
The regionally bbased<br />
National Health h Service (Servizio Sanitario<br />
Nazionale (SSNN)<br />
provides universal coverage free of charrge<br />
at the point of servvice.<br />
The national levvel<br />
is responsible for <strong>en</strong>suring e the g<strong>en</strong>eral oobjectives<br />
and fundamm<strong>en</strong>tal<br />
principles of thee<br />
national health care ssystem.<br />
Total exp<strong>en</strong>dituure<br />
on health as a prop portion of gross domestic<br />
product (GDP) haas<br />
ris<strong>en</strong> from 7.9% in 11990<br />
to 8.7% in 2007.<br />
Health care spe<strong>en</strong>ding<br />
per capita: $2,6 686<br />
Voluntary healtth<br />
insurance (VHI) doe es not p<strong>la</strong>y a significaant<br />
role in funding heaalth<br />
care in Italy. Sp<strong>en</strong>nding<br />
on VHI, both ass<br />
a perc<strong>en</strong>tage of totaal<br />
exp<strong>en</strong>diture and of private<br />
exp<strong>en</strong>diture, is well under 5%.<br />
Primary care is provided by GPs and d paediatricians.<br />
Average numbeer<br />
of GPs per 1000 resid<strong>en</strong>t<br />
popu<strong>la</strong>tion is 1. .19 (2005).<br />
Most GPs operrate<br />
in solo practices, group g practices and networks.<br />
In 2004, each GGP<br />
averaged 1107 pati<strong>en</strong>ts.<br />
Pati<strong>en</strong>ts are alllowed<br />
to access spec cialist care either throuugh<br />
a referral by theirr<br />
GP or for some servvices,<br />
by directly bookking<br />
an appointm<strong>en</strong>t thhemselves<br />
through a c<strong>en</strong>tral<br />
booking point.<br />
GP paym<strong>en</strong>ts fflow<br />
through a combin nation of capitation annd<br />
fee-for-service—soometimes<br />
re<strong>la</strong>ted to performance—and<br />
are regu<strong>la</strong>ted under a naational<br />
contract and reegional<br />
agreem<strong>en</strong>ts.<br />
Situation before Pati<strong>en</strong>ts in need<br />
of help after-hours care c contacted their inndividual<br />
GP or refereed<br />
themselves to a local<br />
hospital and in some<br />
regions rota systeems<br />
were organized byy<br />
small<br />
reform<br />
groups of GPs.<br />
Drivers for systemm<br />
Not applicable.<br />
reform of afterhours<br />
care<br />
Type of reform and<br />
The organizatioon<br />
of after-hours care in each region (20) is <strong>la</strong>id down by <strong>la</strong>ws and<br />
agreem<strong>en</strong>ts in whicch<br />
professional represe<strong>en</strong>tatives<br />
have an actiive<br />
role to p<strong>la</strong>y: servicces<br />
and<br />
type of reform rotas, standards<br />
regarding the workfo orce and deputising ruules.<br />
The district emmploys<br />
after-hours care e doctors and must e<strong>en</strong>sure<br />
after-hours GPP<br />
care and the avai<strong>la</strong>bbility<br />
of medicines and<br />
necessary equipme<strong>en</strong>t.<br />
It also provides ddoctors’<br />
surgeries, healtth<br />
supplies and servic ce vehicles.<br />
During regu<strong>la</strong>r hours, care is provid ded by GPs; there is a handover to after-hours<br />
service doctorss<br />
(medici di continuitàà<br />
assist<strong>en</strong>ziale) for nnights,<br />
week<strong>en</strong>ds and public<br />
holidays, a full--time<br />
AH service 24/24 4 (via 118), an ambu<strong>la</strong>ance<br />
service and the hhospital<br />
A&E services.<br />
If they wish, ge<strong>en</strong>eral<br />
practitioners ca an also become involvved<br />
in after-hours servvices:<br />
they th<strong>en</strong> have two differ<strong>en</strong>t contractss<br />
(one with the national<br />
governm<strong>en</strong>t and onne<br />
with<br />
the region).<br />
Number of actual After-hours care<br />
is provided by after-hours<br />
doctors operating<br />
from an after-hourss<br />
care point.<br />
models used:<br />
Type of models After-hours servvices<br />
provided by afte er-hours doctors operaating<br />
from and after-hoours<br />
primary care poinnt:<br />
After-hours docctors<br />
have no specific c training but hold a gg<strong>en</strong>eral<br />
practitioner (eev<strong>en</strong><br />
specialist) diplomma,<br />
and perform thesse<br />
duties for five to eight<br />
years before settting<br />
up<br />
practice.<br />
If an after-hourss<br />
doctor receive a call<br />
while on duty rota, thhey<br />
follow specific prootocols;<br />
if they visit a ppati<strong>en</strong>t<br />
(or vice versa) they give him or her a form that has to be ppassed<br />
Results<br />
125
Change language