Author: P. De Santis
Date: 6 November 2013
Type: Policy Brief
In recent decades, the Italian Healthcare System has achieved remarkable improvements, as demonstrated by the increase in the life expectancy, as well as the progressive decrease in the mortality rate. Nevertheless, numerous challenges still lie ahead in ensuring the achievement of a greater universality and fairness in the System, as the Constitution aims to establish. Specifically, the challenges to tackle concern: the fairness in terms of the quality and access to healthcare services, the financial sustainability of the System, the financial protection for individuals and households that sustain substantial Out of Pocket expenditures and the extent to which the healthcare research contributes to the economic development of the country. Therefore, in a framework of increasing demand for healthcare services, rising costs, reduced financial resources and increasing European integration, we strongly believe that the current debate, mainly focused on how to attain budget savings, only partially takes into account the nature and the extent of the current issues.
In this context, we propose an Healthcare Roadmap 2030, consisting of a comprehensive set of structural reforms able to address the areas of improvement and to tackle their underlying determinants. In particular, with regard to the challenges ahead, we stress: the limited transparency and accountability in the performance of the overall System, the methodologies of resource allocation to the various levels of the system, which tend to generate inefficiency and increase costs, and finally the limited availability of high management skills, the latter being mainly due to the arbitrary mechanisms of selection, evaluation and removal of the high-level management and to a weak management of the human resources.
The paper is divided into four chapters. The first two are devoted to the analysis of: the results achieved by the Italian Healthcare System over the last decades, the areas where improvement can be achieved and, more precisely, the obstacles that prevent such improvements to take place automatically. Hereinafter, the second part of the document outlines our vision of the 2030 Healthcare System and the basic values underlying the
pillars of the System reform: (i) strengthening the governance, in order to intensify the leeway and the capability of management and control of the System, also minimizing conflicts of interest and arbitrary policy interventions (ii) empowerment of patients through increased transparency and availability of healthcare data, in order to provide them with an effective capability of selection with regard to the place of care and to the physician. We believe that the resulting higher competition would also increase the productivity and quality of the services provided, enable the relation of the reimbursement of the services to their actual value, and finally allow companies to make more productive investments whose benefits are more directly transferred to patients. (iii) establishment of a clear system of Consequence management and incentives, in order to enable public managers to optimize their managerial performances. (iv) revision of the funding model, correlating the funds to the outcomes achieved, in order to encourage / reward good behaviours. Finally, as far as the Regions with budgetary constraints are concerned, on the one hand we propose to operate a restructuring of the outstanding debt they have incurred over time and, on the other, to operate a real management turnaround based on the adjustment of their programme along the following three dimensions: (a) structure (b) governance (c) managerial skills.
We are confident that the strategic guidelines established in this paper, which will be followed by specific proposals for each issue raised, will contribute to a factual, non- ideological and open debate, able to attract the international best practices in order to reform a System which struggles to ensure its universality and fairness: the principles underlying its foundation in 1978.
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