The Health Care System in Italy and Lombardy Alberto Daprà Vice Chairman Lombardia Informatica Lodz 20 September 2011
Lombardy Region Is one of the twenty Italian Regions About 16% of Italy s citizens Is one of the most populated Regions of Europe (more populated than 14 EU member States) The number of inhabitants per Km 2 is 6 times Bulgaria s Its GNP is about 20% of Italy s GNP 2
General Information (1/4 ) Lombardy Italy % Lombardy Year of Data Municipalities 1.546 8.093 19,1 2010 Surface (kmq) 23.861 301.338 7,9 2010 Residents 9.917.714 60.626.442 16,4 2010 Female % 51,2 51,5 16,3 2010 Foreign % 10,0 7,0 23,2 2009 20 Regions Lombardy is one of the most populated Regions of Europe (more populated than 14 EU member States) 3
Lombardy Italy General Information (2/4) Local Health Units General Practioner Year 2004 2005 2006 2007 2008 195 195 180 171 157 47.061 47.022 46.478 46.961 46.510 Paediatricians 7.416 7.459 7.526 7.657 7.649 Local Health Units 15 15 15 15 15 General Practioner 6.922 6.801 6.717 6.638 6.544 Paediatricians 1.033 1.070 1.098 1.122 1.126 4
General Information (3/4) Pharmacies Pharmacies Number Resident Residents for Pharmacy Total Private Public VALLE D'AOSTA 49 42 7 127.065 2.593 PIEMONTE 1.536 1.432 104 4.432.571 2.886 LIGURIA 593 570 23 1.615.064 2.724 LOMBARDIA 2.782 2.357 425 9.742.676 3.502 VENETO 1.316 1.211 105 4.885.548 3.712 BOLZANO 118 118-498.857 4.228 TRENTO 165 138 27 519.800 3.150 FRIULI-V.GIULIA 366 345 21 1.230.936 3.363 EMILIA-ROMAGNA 1.230 1.028 202 4.337.979 3.527 MARCHE 493 419 74 1.569.578 3.184 TOSCANA 1.109 889 220 3.707.818 3.343 LAZIO 1.474 1.321 153 5.626.710 3.817 ABRUZZO 501 468 33 1.334.675 2.664 UMBRIA 269 218 51 894.222 3.324 MOLISE 168 164 4 320.795 1.909 CAMPANIA 1.606 1.556 50 5.812.962 3.620 PUGLIA 1.097 1.071 26 4.079.702 3.719 BASILICATA 204 201 3 590.601 2.895 CALABRIA 760 759 1 2.008.709 2.643 SICILIA 1.419 1.407 12 5.037.799 3.550 SARDEGNA 541 532 9 1.671.001 3.089 Totale nazionale 17.796 16.246 1.550 60.045.068 3.374 5
General Information (4/4) Structures in Lombardy Hospitals 35 Public 30 Research Institutions 5 Private Structures 310 Hospitals 70 Laboratories etc. 240 Total 345 More than 150.000 operators in the Health Care structures. 6
Gross National/Regional Product Region mil. per cap. Regional on GNP Area Abruzzo 28,73 21,60 1,8% South Aosta Valley 3,88 30,60 0,2% North-West Apulia 69,55 17,10 4,4% South Basilicata 11,41 19,30 0,7% South Calabria 33,26 16,60 2,1% South Campania 96,32 16,60 6,1% South Emilia-Romagna 138,68 32,20 8,8% North-East Friuli-Venezia Giulia 36,18 29,50 2,3% North-East Lazio 174,12 31,10 11,1% Centre Liguria 44,13 27,40 2,8% North-West Lombardy 328,22 33,90 20,9% North-West Marche 41,68 26,70 2,7% Centre Molise 6,51 20,30 0,4% South Piedmont 127,01 28,80 8,1% North-West Sardinia 33,18 19,90 2,1% Islands Sicily 84,54 16,80 5,4% Islands Tuscany 106,06 28,70 6,8% Centre Trentino-Alto Adige/Südtirol 33,16 32,80 2,1% North-East Umbria 21,85 24,60 1,4% Centre Veneto 149,39 30,70 9,5% North-East GNP 1.567,85 100,0% Data 2008 7
The Italian Health Care model In 1978 Italy adopted a tax-funded universal health care system called "National Health Service" (in Italian: Servizio Sanitario Nazionale SSN), which was closely modeled on the British system. The SSN covers general practice (distinct between adult and pediatric practice), outpatient and inpatient treatments, and the cost of most (but not all) drugs and sanitary ware. The government sets LEA (fundamental levels of care, Livelli essenziali di assistenza in Italian) which cover all necessary treatments, which the state must guarantee to all, paid for by the government, or for a "ticket", a share of the costs (but various categories are exempted). The public system has also the duty of prevention at place of work and in the general environment. In 1997, when Italy's national government decentralized the country's health-care system, giving the regions control over the public money that goes to hospitals within their own borders. The money still comes from the central government, which also determines what methods and drugs must be included in various treatments in order to meet national health-care standards. But each region now has the power to adopt additional quality standards, to set its own reimbursement rates, to decide which hospitals qualify for public funds, and to withhold reimbursement if hospitals don't meet the proscribed standards. 8
The Health Care model in Lombardy In much of the country, regions have continued to use the standards of care and reimbursement rates recommended by National Government. Some also give preferential treatment to public hospitals, making it more difficult for private hospitals to qualify for public funds. Lombardy, by contrast, has increased its quality standards, set its own reimbursement rates and, most important, put public and private hospitals on an equal footing by making each equally eligible for public funds. If a hospital meets the quality standards and charges the accepted reimbursement rate, it qualifies. Patients are free to choose between state-run and publicly funded private hospitals at no extra cost. Their co-pay is the same in either case. As a result, public and many private hospitals in Lombardy compete directly for patients and funds. Around 40% of hospital care in Lombardy is private now more than anywhere else in Italy. 9
Lombardia Informatica SpA 100% owned by Regional Government Cannot compete with Private Companies in Italy Can be involved in Projects abroad Responsible for the soundness and the effectiveness of the whole Regional Information System Responsible for technological innovation Unique interface between Regional Government and the marketplace Provider of development and maintenance for Regional Information System > 650 people > 200Mln 10
The ICT program for Health in Lombardy In 1999 the Regional Government of Lombardy started a large ICT program to support Health provision involving all the actors: GP and Pediatricians Public and Private Hospitals Laboratories Pharmacies. The Program is named Sistema Informativo Socio Sanitario - SISS Lombardia Informatica is responsible ofthe management and development of the Program. 11
Lombardy created a Public Private Partnership teaming up with private companies, to launch the project Partnership Between Public and Private Supervision (Lombardy Region) Governance (Lombardia Informatica Lombardy s ICT agency) Health Care Services Infrastructure (extranet, smart cards, ) Training and Promotion Supply: Private Companies (LISIT partners/shareholders) Demand: LISIT (Lombardy Owned Newco) 12
SmartCards Citizen Card Identification and authentication Data storage required for emergency care (Netlink standard) Access to Public Administration services Certification of the presence of the Citizen (through electronic signature of documents) Operator Card Identification and authentication Authorization access to the System (according to operator s profile) Electronic Signature 13 EHealth Platform in Lombardy Region
CRS at the center of citizen s life egovernment online services ehealth (CRS-SISS) Health service payment Public libraries Welfare services Fuel discount card Access Control Deployed Test phase Study phase Transportation Private Services (parking, discount, fidelity, eticketing...) 14 EHealth Platform in Lombardy Region