Human Body Systems Relationships

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Italy

CHAPTER 9

Key Concepts

  • Capitation – A method whereby insurance companies reimburse providers such as physicians and nurse practitioners; a preset amount for services given to the patients enrolled in their practices
  • Co-payments – The third party payer, such as an insurance company, pays the major portion of the medical bill and the patient pays a significantly lower portion of the bill. For example, if the visit to the physician or specialist is 150.00, the patient may be responsible for a co-payment of $20-40

Key Concepts

  • DRGs – Diagnostic related groupings – Predetermined fees set by grouping similar problems under 468 categories; a negotiated fee-for-service, per diem, and capitation.
  • Essential Levels of Care – The core package of health care benefits
  • Hospital Trusts - Units of care that provide secondary and tertiary care
  • National Health Service (NHS) – Italy’s system of health care

Introduction and Country Overview

  • OCED Status and founding member of the European Union
  • Literacy rate – 99%
  • Industrialized Country
  • World’s seventh largest economy
  • Main language – Italian
  • Largest ethnic group - Italian

Introduction and Country Overview

  • A healthy population
  • Infant mortality rate 3.38 per 1,000 live births (CIA, 2011)
  • Life expectancy – 84.53 for women; 79.16 for men (CIA, 2011)

Population Challenges

  • Persistent low fertility rates
  • Current estimates indicate fertility rate at 1.39 below recommended replacement level of 2.1
  • A decline in younger age groups
  • A rapidly aging population
  • By 2040 the population over 65 estimated to increase by 40%

Historical

  • National Health System established in 1978
  • Regions gain more decision authority for health care - early 1990’s
  • Several cost containment measures implemented (e.g., price controls on drugs) – early 1990’s

Structure

  • Ministry of Health – central organization of the NHS
  • Regions ensure access to the NHS benefits package through
  • Local Health Agencies – geographically situated to serve specific populations
  • Hospital Trusts and University Hospitals provide secondary and tertiary care

Structure

  • One of the highest number of physicians worldwide (approx. 37 doctors per 10,000)
  • Growing nursing shortage due to
  • Budget constraints
  • Increased specialization
  • Retirement
  • Negative bias toward the profession

Financing

  • National and Regional Taxation
  • The Benefits Package: Essential Levels of Care under NHS
  • Physicians paid on capitation basis
  • Health Expenditures – total health spending above the average of OCED countries (approx. 9%- 10 %)

Financing

  • Decentralization
  • The state and the regions share responsibility for the benefits package
  • However in practice, the regions control administration of funding and regulating health care
  • Regional Differences
  • tax revenues favor regions with a stronger industrial economy

Interventional

  • GPs provide most of the primary care
  • Long-term Care: 3 modalities
  • Residential
  • Community-based
  • Cash benefits

Interventional

  • Long-term Care Issues
  • Lack of an integrated network of delivery between health and social care services
  • Regional differences in public expenditures for long-term care
  • Inadequate funding of personal social services

Preventive

  • Syndromic Surveillance Systems
  • Major objective of The National Health Plans 2006-2008 (Donfrancesco et. al., 2008)
  • Cardiovascular training for GPs
  • Heat Health Watch Warning Systems (HHWWS)
  • Italy lost nearly 4200 lives in the heat wave of 2003

Resources

  • Home remedies including use of healers, potion makers – especially practiced by older Italians
  • Growth of alternative medicine – especially attractive to women aged 35- 44
  • Three most popular practitioners consulted
  • Herbalists
  • Nutritionists
  • Homeopaths

Top Ten Causes of Death

Ischemic Heart Disease

Cerebrovascular Disease

Trachea, bronchus, lung cancers

Hypertensive heart disease

Chronic obstructive pulmonary disease

Diabetes mellitus

Colon and rectum cancers

Lower respiratory infections

Alzheimer and other dementias

Breast cancer (WHO, 2002)

% Years of Life Lost to Disease

  • Ischemic heart disease - 16%
  • Cerebrovascular heart disease - 12%
  • Trachea, bronchus, lung cancers – 6%
  • Hypertensive heart disease - 4%
  • Chronic obstructive pulmonary disease – 4%
  • Diabetes mellitus – 3%
  • Colon and rectum cancers – 3%
  • Lower respiratory infections – 3%
  • Alzheimer and other dementias – 2%
  • Breast cancer – 2% (WHO, 2002)

Regional Disparities

  • Socio-economic differences affect distribution of health care services
  • The North-South Divide
  • The developed industrial North: residents have better access to health care
  • The welfare dependent South: residents report less satisfaction with services