Improved quality , safety and containing healthcare costs : too good to be true ?

1. Improvedquality, safety and containinghealthcarecosts: toogood to be true? Bruxelles – 21 February 2013 Claudio Dario, Director General, Padua Teaching Hospital, Veneto Region, Italy

2. The current scenario • The effects of the crisis on Italy, as in the other European Countries, are noticeable from multiple factors. In particular: • growth of public debt • decrease of production and of GDP • increase of unemployment

3. Growth of public debt Source: ItalianMinistry of Treasure, 2012

4. Growth of public debt Public debt / GDP ratio in UE Contries, 2011 Source: ItalianMinistry of Treasure, 2012 • [source: Eurostat, 2012]

5. decrease of production and of GDP The Italian GDP 2007-2011 and forecasts 2012-2013 [Source: The perspectives for italian economy 2012-2013, Italian Bureau of Statistics (ISTAT), 5-nov-2012]

6. Increase of unemployment The amount of Unemployed by class of age 1993-2011 (thousands) Source: Italian Bureau of Statistics (ISTAT), 2012

7. The amount of Unemployed by class of age 1993-2011 (thousands) Source: OECD, 2013

8. The current scenario • But in Italy a good social safety net is in place: • extensive use of layoffs (“cassa integrazione”) • unemployment compensations (“sussidi di disoccupazione”) • family protection network • household wealth • house of property (the 77,1% of italians live in a house of property*) • savings and financial activities [*Source: Survey on savings and financial choices of Italians 2012, Intesa San Paolo, 2012]

9. Extensive use of Layoffs (“cassa integrazione") • [Source: Italian Bureau of Statistics, ISTAT, 2012]

10. Householdwealth Household wealth to income ratio • Household wealth of italians: 8.619 Billions € on 2011 (almost 4 times the public debt) • 62,8% of real activities, • 37,2% financial activites, • 9,5% financial liabilities. • 10% of italians owns the 45% of wealth • the net wealth is almost 8 times the income • [source: Bank of italy, 2011]

11. The Italian National Health Service HealthInsurancecoverage • Italy has a tax-funded National Health Service that guarantees universal provision of comprehensive care • The central government provides a politicy and planning frameworks, defines the Essential Levels of Care and guarantees the financial sustainability • The regions, through public and private providers, deliver the Essential Levels of Care (sometimes additional to the minimal set defined by the Ministry of Health) and are liable for any deficit Source: “Healthat a GlanceEurope 2012”, OECD, 2012

12. The Italian National Health Service • In the 2006-2010 period the medium increase rate of expenditure was 2,2%, but in 2001-2006 it was higher: 7% Source: ItalianMinistry of Health, 2012 • The total healthcare expenditure is continuosly increasing: the reduction of the increase of the public funding over the years is compensated by a raising private expenditure

13. The deficit of the National Health Service The trend of the deficit of Italian NHS National trend Billion € Trend for regions with recovery plan Trend for regions without recovery plan Year Source: ItalianMinistry of Health, 2012

14. The deficit of the National Health Service The polarization of the deficit of Italian NHS among some Regions Year 2011 (Million €) 85% of the total deficit -815,1 Source: The European House-Ambrosetti, 2012

15. The deficit of the National Health Service • In the 2001-2011 period Regions generated over 40 Billion € of cumulative deficit Source: ItalianMinistry of Health, 2012 • Since 2001, Italian government establishes limits to the increase of public expenditure • Since 2007, regional recovery plans (Piani di Rientro) are adopted for overspending regions • On 2010, further policies has been provided by the Ministry to increase traceability, accountability and appropriateness of the Health Service (Patto per la Salute 2010-12) • 2012: Spending Review

16. The healthexpenditure of italian NHS Source: OECD Data Health, 2012

17. The areas of action • Reduction of Hospital Beds • Organization of hospital beds over the territory (Hospital, ElderlyHomes, Nursing Homes, etc…) by intensity of care (acute/cronicaldisease). • 3.5 Hospital Beds/1.000 inhabitants on 2010 [Source: OECD], where the EuropeanAverageis 5.5 • Reorganization of the network of Hospital Assistance depending on High Specialty • Hub & spoke networks, pathology networks, etc… • Organization of the continuity of care: • Primary care, Home Care, specialisticassistance, palliative care, residential care, etc... • Appropriateness of hospital admissions: reduction of the number and of the duration of hospitalizations • Conversion of day-hospital activities to out-patientregimen, and of hospitalizations to day-hospital activities, with the introduction of co-payment • Activation of week-surgery and development of day-surgery

18. The areas of action • The National government cut the transfers to regions for disability, childhood, migrants and other welfare policies • Introduction of cost-saving measures aimed to reduce pharmaceutical expenditure • Increase of indirect business tax (IRAP) to finance healthcare system • Elimination of obsolete Essential Levels of care

19. Improved quality, safety and containing healthcare costs: too good to be true?

20. Thank you! Claudio Dario Director General, Padua Teaching Hospital, Veneto Region, Italy

21. The healthexpenditure of italian NHS Source: OECD Data Health, 2012