Regional Healthcare Systems:
equal care and accessibility for all?

In pursuing its efforts to make the healthcare system more sustainable, the government must reinforce its role in setting guidelines and monitoring regional healthcare systems in order to guarantee equal services at least in terms of basic care levels throughout the country and with them greater equality of care for all citizens.

Regional Healthcare Systems: equal care and accessibility for all?

The reform of Title V of the Constitution approved in 2001, that differentiates between exclusive and concurrent legislative competence of national and regional government, on the one hand made it possible for the regions to create healthcare systems “customized” to their individual situations, but on the other made the task of central government more difficult in assuring equal basic care levels throughout the country, exactly because of regional differences. In addition, public spending constraints, the on-going economic crisis and continued cuts in the healthcare sector are threatening the ability of the different systems to safeguard care to especially the weakest and most needy segments of the population.

The Meridiano Sanità Regional Index, created by The European House – Ambrosetti, is designed to provide a multidimensional assessment of regional healthcare systems through comparison of their performance, both between each other and in terms of the national average, and identify the areas of greatest discrepancy between the different regions. (Find here the full Meridiano Sanità Report).

The Index is based on a significant number of indicators—40 key performance indicators—that represent the different key aspects of regional healthcare systems. These have been grouped into four areas of analysis:

  1. State of health of the population: Assesses the results of the healthcare system in terms of the health of the population using indicators for life expectancy, health risk factors, comorbidity and mortality for those pathologies with greatest impact on the system.
  2. Equality and capacity of the healthcare system to respond to health needs: Assesses the extent to which regional healthcare systems are equitable in guaranteeing care to all citizens and how they are organized to respond to the challenges of prevention, management of elderly patients within their jurisdiction and access to pharmaceutical innovation to offer citizens new therapeutic solutions.
  3. Efficiency and appropriateness of healthcare services: Assesses the level of efficiency of the system, from both a management and organizational level, and the appropriateness of the services provided.
  4. Quality of healthcare and responsiveness of the system: Assesses the quality of the system, seen as the clinical quality of the services provided, the quality of the services provided as perceived by the public and, in general, the ability of the system to respond to user expectations.

On the basis of analysis results, Emilia Romagna (7.3) and Lombardy (7.0) have the best performance levels, followed by Tuscany and Trentino Alto Adige with scores of 6.9. In comparison, all the regions in the south of Italy have scores below the national average.

There are areas of the study in which the regional discrepancies are more marked than others. The state of health of the population, which is still one of the best in Europe, also has the lowest discrepancy level, an indication that in comparison with the rest of Europe, all Italian regions score well.

In terms of equality and ability to respond to health needs—the area in which Italy is most penalized in comparison with other European countries—the level of discrepancy is the highest. This indicates that the national performance average is drastically lowered by the regions in southern Italy which, in terms of prevention, care of the elderly and chronic diseases, and equity of the system, must make a number of steps forward.

Meridiano Sanità Regional Index 2015-en

Putting together the healthcare expenditure of the regions—which indicates the amount of resources earmarked for such a fundamentally-important sector—with the performance levels registered in the Meridiano Sanità Regional Index, what emerges is that the regions with the best results are also those with a higher  level of public and private expenditure. In addition, these regions, all in the north of Italy, are also richer regions. The results for regions in the south are the opposite, in other words, with worse performance and lower levels of public expenditure.

Therefore, there is a strong correlation between the wealth of a region, the resources it allocates to healthcare and the performance results of the public healthcare system.

Per capita heatlhcare expenditure 2014

For further information, please refer to Chapter 5 of the Meridiano Sanità Report, “Performance Levels of Regional Healthcare Systems”.

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