Abstract Chapter 4

Chapter 4 examines the INHS with regard to institutional makeup, infrastructure endowment, healthcare utilization and overall patient needs satisfaction. The analysis reinterprets the most recent data published by the Ministry of Health and by the National Agency for Regional Healthcare Services (Age.Na.S.) through their National Outcomes Plan (Piano Nazionale Esiti), further integrated with evidence on the determinants of health needs and utilization based on studies carried out by ISTAT between 2016 and 2017. The fledgling Azienda Socio Sanitaria Territoriale (ASST), established by the Lombardy Region during the recent institutional restructuring process and charged with providing both inpatient and outpatient services on the public service side, are now included among local health authorities. In addition, a new category has been added which contains all intermediate bodies that operate in the space between the Assessorship and the local health authorities carrying out either governance or support (or sometimes both) functions in the healthcare sector only. In light of this new classification, the number of health authorities (including the ASST) is now 120, the Hospital Companies (Aziende Ospedaliere) have fallen to 43 units, while the intermediate bodies total 17, including the 8 Agenzie di Tutela della Salute (ATS) established in Lombardy. The infrastructure endowment showed a decrease in the number of hospital beds through 2014 (last available data), although this trend is limited to inpatient care beds (-40% compared to 1997). Day hospital beds, on the other hand, have slightly increased during the same time span (+6%), although since 2008 certain services and procedures have been increasingly carried out in outpatient settings. Hospital admissions show a downward trend as well, with a significant decrease between 2011 and 2015 (-28%) that is aligned with the resource trend. As to the birth centers, more than half of the regions display an extremely fragmented network, with more than one center every 1,000 live births. Finally, meeting care needs can be analyzed through indirect measures only: traveling for care appears to be essentially stable; waiting times are longer for operations and interventions that do not impact patient survival directly; the percentage of chronic patients in good health decreases with age and shows lower values in the southern part of the country.