A regional approach to the provision of health and social care: consequences for building design and use

Transcription

1 EuPHN 2014 Workshop 1-3 October 2014, Edinburgh A regional approach to the provision of health and social care: consequences for building design and use Luigi Bertinato MD Medical Director Heath Care Authority n.22 Bussolengo Verona,, ITALY

2 Bussolengo, Verona L. BERTINATO - HEALTH Veneto CARE AUTHORITY Region N. 22, VENETO REGION

3 Overview 1. The Italian Health Care System 2. Integration between hospital & out-of-hospital health & social care in the 3. The Health Care Authority n. 22, Verona (Veneto Region) 4. Building and design use before and after the Veneto Social Health Care Plan (2012) 5. Conclusions

4 History of the Italian National Health System (NHS) BEFORE 1978 AFTER 1978 Otto von Bismarck William Henry Beveridge

5 The history of the Italian National Health System (NHS) NHS founded in 1978 (L.833/1978) Major reform launched in 1992 and in 1999 (D.L.gs502/1992, D.L.gs229/1999) Decentralisation, Modification of the Constitution (L.C.3/2001) and Fiscal Federalism(D. L.gs56/2000)

6 Basic Principles Universal Coverage and free access (solidarism) Democratic control (through the political system) Decentralisation (three tiers of government involved in running the system) Statalism (services should be mainly provided by government-owned entities) (but private sector included in 1978) Integration of health care activities (all services provided by one organisation)

7 Funding and allocation of resources General Taxes and other contributions The State allocate resources to the 21 Regions (depending on size of population + historical spending) The Regions allocate resources to Local Health Care Authorities Overspending (national control on how NHS organisations spend)

8 The Reform of Vth Title of the Constitution The only task of the State is to fix the so called LEA : Essential Levels of Health Care provision, limited to civil and social rights; All domains concerning human health come under the legislative function of the Regions with the sole responsibility for guaranteeing the Essential Levels of Health Care and for respecting the fundamental principles deriving from State Legislation in force.

9 Institutional and political structure National Government (Ministry of Health) Regional Government (Regional Ministry of Health) Local governments (Municipalities used to appoint Management Committee of Local health Units LHUs)

10 health care system Population size: 4.9M Surface Area(km2): 24,840

11 The Veneto s responsibility in policy-making in the health & social areas Minister for Health Policies Minister for Social Policies Regional Director for Health & Social Services 21 Local health Authorities 2 University Hospitals 1 Regional Cancer Inst. 582 Municipalities In the Veneto Region Municipality board of mayors

12 The Population Structure (2013 ISTAT data) VENETO ITALY Total population: ,786,668 N. Families: 2,048,851 25,805,504 Members per family: Birth rate: Death rate: Natural growth rate Total growth rate: Elderly persons index % % population >65 years: 19.9% (compared to a EU average of 14.08%) Total Veneto production facilities: * (*high proportion of small-medium sized, and family-based companies)

13 Financial Reporting: Region to State Annual Budget Prediction Before 31st December of each financial year, the Region has to make anticipated income and expenditure predictions for the following year based on financial reports made by all local health units, to be submitted for approval The State is responsible for consolidating all economic information provided by the Regions to be compilted into a final financial report to be presented before Italian and European Institutions Regional budget allocation for Healthcare in 2013: 8.5 Billion Regional investment allocated to the Social Sector: 670 Million L. Bertinato,

14 The ageing of the population 19,9% are > 65 years old Veneto residents: % of elderly people live alone 62% are > 75 years old 80% are women The incidence of > 65 has grown from 18% to 20% and of > 75 from 8% to 10%.

15 L. BERTINATO - HEALTH Veneto CARE AUTHORITY Region N. 22, VENETO REGION

16 The Veneto Social and Healthcare Model...departs from the articulation of the 3 following healthproviding bodies: Department of Prevention District Hospital The Essential Levels of Health Care Provision (ELHC or LEA) include: In- patient and hospital health care Specialist health care Pharmaceutical care Integration between Social & Health care

17 Hospitals Network Health System has 71 hospitals in its health care public network: 42 Public HCA Hospitals 2 Public Hospital Enterprises 1 Veneto Cancer Institute (IRCCS) 26 Private Accredited Hospitals 45 public hospitals: beds 26 private hospitals: beds L. Bertinato - Health Care Authority n. 22,

18 Total number of acute hospital beds: average days of stay = 8.2

19 Standardized hospitalization rate per 1,000 inhabitants in Veneto

20 Cost of hospital care per resident

21 The new al Health Plan (2012) L. BERTINATO - HEALTH Veneto CARE AUTHORITY Region N. 22, VENETO REGION

22 1) The Strategy: reducing beds and Reinforcing the Emergency Network in Veneto L. BERTINATO - HEALTH Veneto CARE AUTHORITY Region N. 22, VENETO REGION

23 2) Improving the Integration between the Health & Social Sectors of the the Region and Municipalities 582 MUNICIPALITIES share with the 21 local health units the responsibility of planning the system to provide health and social services to citizens and more vulnerable groups Areas of the Community Health Plan with a strong integration between the Health and Social Services focus on: The elderly The disabled Young people and their families Drug and alcohol prevention Mental health Socially excluded people Immigrants 269 Residential community-based services: beds Community Health Plans (CHP) are developed between each of the 21 local health units and 582 municipalitiies of the territory Regular convening of the Permanent Committee between LHU Director Generals & the Conference of Mayors (ratio 1:78)

24 3) Investing on Intermediate Hospitalization Structures (DGR n.2718 del 24 dicembre 2012) In literature they are defined as a kind of services close to home care, with the main purpose to ensure: an early discharge from hospital; a viable alternative to an hospitalization potentially not appropriate.

25 Intermediate Hospitalization Structures (DGR n.2718 del 24 dicembre 2012) Classification Comunity Hospital DGR n. 2817/2012 Territorial Rehabilitation Unit DGR n. 2827/2012 Hospice DGR n. 3318/2008

26 L. BERTINATO - HEALTH Veneto CARE AUTHORITY Region N. 22, VENETO REGION

27 The is divided into 23 Health Care Authorities (LHAs) The HC Authority n.22

28 Health care management in Health Care Authority n.22 General Director Medical Director Administrative Director Director of social and out of hospital services

29 Care dimension Regional Operational Centers h24 New Regional Health Plan: New role for the Director of Social Services with the new responsibility for Out-of-Hospital Services Nursing Staff Health care district Unit for Primary care Unit for Palliative Care Unit for Specialist Care Unit for Maternal, Childhood and family care Unit for Disability and long-term diseases Organizational dimension

30 The Health Care Authority n.22, Hospital/out of hospital reorganization according to the new Regional Health & Social plan: from 7 to 2 acute hospitals HD 2 Public Hospitals 3 Private Hospitals Ambulatory services for tourists Hemodialysis Population size: inh. Total n. acute public & private beds = 1312 Total n. intermediate beds = 226

31 Bussolengo Hospital ACUTE DISEASE HOSPITAL BEDS: REGIONAL HEALTH AND SOCIAL CARE PLAN ACUTE DISEASE BEDS: 91 REHABILITATION BEDS: 15 TOTAL BEDS: 106

32 Villafranca Hospital ACUTE DISEASE HOSPITAL BEDS: REGIONAL HEALTH AND SOCIAL CARE PLAN ACUTE DISEASE BEDS:170 REHABILITATION BEDS : 24 TOTAL BEDS: 194

33 Intermediate Hospitalization Structures (DGR n.2718 del 24 dicembre 2012) The hospital and the Intermediate Hospitalization Structures have two different missions

34 Malcesine Hospital REHABILITATION BEDS: REGIONAL HEALTH AND SOCIAL CARE PLAN ACUTE DISEASE BEDS: 15 REHABILITATION BEDS: 35 TOTAL BEDS: 50

35 Isola della Scala Hospital ACUTE DISEASE HOSPITAL BEDS: REGIONAL HEALTH AND SOCIAL CARE PLAN COMMUNITY HOSPITAL BEDS: 40 HOSPICE BEDS. 10 SOCIAL HEALTH DISTRICT (DSS)

36 Caprino Hospital ACUTE DISEASE BEDS:16 COMMUNITY HOSPITAL BEDS: REGIONAL HEALTH AND SOCIAL CARE PLAN COMMUNITY HOSPITAL BEDS: 10 SOCIAL HEALTH DISTRICT (DSS with Family Counselling Service )

37 Valeggio Hospital ACUTE DISEASE HOSPITAL BEDS: REGIONAL HEALTH AND SOCIAL CARE PLAN COMMUNITY HOSPITAL BEDS: 10 SOCIAL HEALTH DISTRICT (DSS) LOCAL CENTER for PRIMARY CARE (UTAP) DEPARTMENT of PREVENTION

38 Integration tool and continuity of care: the Regional Operation Centre H.beds = Residential communitybased services: beds Beds:226

39 L. Bertinato - Health Care Authority n. 22, Hospital/Out of Hospital HC Model PATIENT ADMISSION TO THE HOSPITAL PATIENT DISCHARGE FROM THE HOSPITAL Rehabilitation H. Community H. (30 to 60 days) HOME CARE

40 Conclusions Integration between health and social services has proven able to respond to the new population needs; Integrated care structures can contribute to the reduction in acute beds length of stay from 8.2 to 7.0 and to a more rational use of hospital buildings; Re-organization of the Health Care System in Veneto is the main strategy for protecting the welfare in a period of economic crisis. L. Bertinato - Health Care Authority n. 22,

41 Thank you for your attention! L. BERTINATO - HEALTH Veneto CARE AUTHORITY Region N. 22, VENETO REGION